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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...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Hindawi Publishing Corporation
2015
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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 |
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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 |
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