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...
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| Format: | Article |
| Language: | English |
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Wiley
2015-01-01
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| Series: | Case Reports in Nephrology |
| Online Access: | http://dx.doi.org/10.1155/2015/372413 |
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| author | Lohit Garg Sagar Gupta Abhishek Swami Ping Zhang |
| author_facet | Lohit Garg Sagar Gupta Abhishek Swami Ping Zhang |
| author_sort | Lohit Garg |
| collection | DOAJ |
| 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 | Article |
| id | doaj-art-f95de26f99144a3598b2df08ee33b3dd |
| institution | Kabale University |
| issn | 2090-6641 2090-665X |
| language | English |
| publishDate | 2015-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Nephrology |
| spelling | doaj-art-f95de26f99144a3598b2df08ee33b3dd2025-02-03T01:09:53ZengWileyCase Reports in Nephrology2090-66412090-665X2015-01-01201510.1155/2015/372413372413Levamisole/Cocaine Induced Systemic Vasculitis and Immune Complex GlomerulonephritisLohit Garg0Sagar Gupta1Abhishek Swami2Ping Zhang3Department of Internal Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI 48073, USADepartment of Nephrology, Washington University in St. Louis, St. Louis, MO 63130, USADepartment of Nephrology, Oakland University William Beaumont School of Medicine, Royal Oak, MI 48073, USADepartment of Pathology, William Beaumont Hospital, Royal Oak, MI 48073, USALevamisole 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.http://dx.doi.org/10.1155/2015/372413 |
| spellingShingle | Lohit Garg Sagar Gupta Abhishek Swami Ping Zhang Levamisole/Cocaine Induced Systemic Vasculitis and Immune Complex Glomerulonephritis Case Reports in Nephrology |
| 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 |
| url | http://dx.doi.org/10.1155/2015/372413 |
| work_keys_str_mv | AT lohitgarg levamisolecocaineinducedsystemicvasculitisandimmunecomplexglomerulonephritis AT sagargupta levamisolecocaineinducedsystemicvasculitisandimmunecomplexglomerulonephritis AT abhishekswami levamisolecocaineinducedsystemicvasculitisandimmunecomplexglomerulonephritis AT pingzhang levamisolecocaineinducedsystemicvasculitisandimmunecomplexglomerulonephritis |