Cargando…

Levamisole/Cocaine Induced Systemic Vasculitis and Immune Complex Glomerulonephritis

Levamisole is an antihelminthic and immunomodulator medication that was banned by the USFDA in 1998. It has been increasingly used to adulterate cocaine due to its psychotropic effects and morphological properties. Adverse reactions including cutaneous vasculitis, thrombocytopenia, and agranulocytos...

Descripción completa

Detalles Bibliográficos
Autores principales: Garg, Lohit, Gupta, Sagar, Swami, Abhishek, Zhang, Ping
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi Publishing Corporation 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4531184/
https://www.ncbi.nlm.nih.gov/pubmed/26290761
http://dx.doi.org/10.1155/2015/372413
_version_ 1782385001728311296
author Garg, Lohit
Gupta, Sagar
Swami, Abhishek
Zhang, Ping
author_facet Garg, Lohit
Gupta, Sagar
Swami, Abhishek
Zhang, Ping
author_sort Garg, Lohit
collection PubMed
description Levamisole is an antihelminthic and immunomodulator medication that was banned by the USFDA in 1998. It has been increasingly used to adulterate cocaine due to its psychotropic effects and morphological properties. Adverse reactions including cutaneous vasculitis, thrombocytopenia, and agranulocytosis have been well described. Despite systemic vasculitis in this setting, renal involvement is uncommon. We report here a case of ANCA positive systemic vasculitis with biopsy proven immune complex mediated glomerulonephritis likely secondary to levamisole/cocaine. A 40-year-old Caucasian male with no past medical history presented with 3-week history of fatigue, skin rash, joint pains, painful oral lesions, oliguria, hematuria, worsening dyspnea on exertion, and progressive lower extremity edema. He had a history of regular tobacco and cocaine use. Lab testing revealed severe anemia, marked azotemia, deranged electrolytes, and 4.7 gm proteinuria. Rheumatologic testing revealed hypocomplementemia, borderline ANA, myeloperoxidase antibody, and positive atypical p-ANCA. Infectious and other autoimmune workup was negative. Kidney biopsy was consistent with immune mediated glomerulonephritis and showed mesangial proliferation and immune complex deposition consisting of IgG, IgM, and complement. High dose corticosteroids and discontinuing cocaine use resulted in marked improvement in rash, mucocutaneous lesions, and arthritis. There was no renal recovery and he remained hemodialysis dependent.
format Online
Article
Text
id pubmed-4531184
institution National Center for Biotechnology Information
language English
publishDate 2015
publisher Hindawi Publishing Corporation
record_format MEDLINE/PubMed
spelling pubmed-45311842015-08-19 Levamisole/Cocaine Induced Systemic Vasculitis and Immune Complex Glomerulonephritis Garg, Lohit Gupta, Sagar Swami, Abhishek Zhang, Ping Case Rep Nephrol Case Report Levamisole is an antihelminthic and immunomodulator medication that was banned by the USFDA in 1998. It has been increasingly used to adulterate cocaine due to its psychotropic effects and morphological properties. Adverse reactions including cutaneous vasculitis, thrombocytopenia, and agranulocytosis have been well described. Despite systemic vasculitis in this setting, renal involvement is uncommon. We report here a case of ANCA positive systemic vasculitis with biopsy proven immune complex mediated glomerulonephritis likely secondary to levamisole/cocaine. A 40-year-old Caucasian male with no past medical history presented with 3-week history of fatigue, skin rash, joint pains, painful oral lesions, oliguria, hematuria, worsening dyspnea on exertion, and progressive lower extremity edema. He had a history of regular tobacco and cocaine use. Lab testing revealed severe anemia, marked azotemia, deranged electrolytes, and 4.7 gm proteinuria. Rheumatologic testing revealed hypocomplementemia, borderline ANA, myeloperoxidase antibody, and positive atypical p-ANCA. Infectious and other autoimmune workup was negative. Kidney biopsy was consistent with immune mediated glomerulonephritis and showed mesangial proliferation and immune complex deposition consisting of IgG, IgM, and complement. High dose corticosteroids and discontinuing cocaine use resulted in marked improvement in rash, mucocutaneous lesions, and arthritis. There was no renal recovery and he remained hemodialysis dependent. Hindawi Publishing Corporation 2015 2015-07-28 /pmc/articles/PMC4531184/ /pubmed/26290761 http://dx.doi.org/10.1155/2015/372413 Text en Copyright © 2015 Lohit Garg et al. https://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Garg, Lohit
Gupta, Sagar
Swami, Abhishek
Zhang, Ping
Levamisole/Cocaine Induced Systemic Vasculitis and Immune Complex Glomerulonephritis
title Levamisole/Cocaine Induced Systemic Vasculitis and Immune Complex Glomerulonephritis
title_full Levamisole/Cocaine Induced Systemic Vasculitis and Immune Complex Glomerulonephritis
title_fullStr Levamisole/Cocaine Induced Systemic Vasculitis and Immune Complex Glomerulonephritis
title_full_unstemmed Levamisole/Cocaine Induced Systemic Vasculitis and Immune Complex Glomerulonephritis
title_short Levamisole/Cocaine Induced Systemic Vasculitis and Immune Complex Glomerulonephritis
title_sort levamisole/cocaine induced systemic vasculitis and immune complex glomerulonephritis
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4531184/
https://www.ncbi.nlm.nih.gov/pubmed/26290761
http://dx.doi.org/10.1155/2015/372413
work_keys_str_mv AT garglohit levamisolecocaineinducedsystemicvasculitisandimmunecomplexglomerulonephritis
AT guptasagar levamisolecocaineinducedsystemicvasculitisandimmunecomplexglomerulonephritis
AT swamiabhishek levamisolecocaineinducedsystemicvasculitisandimmunecomplexglomerulonephritis
AT zhangping levamisolecocaineinducedsystemicvasculitisandimmunecomplexglomerulonephritis