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Published on: July 30, 2013
Cocaine induced vasculitis: have we found a culprit?
Alfredo Sánchez-Cruz1, Sylmarie Marrero, José Betancourt
1Department of Internal Medicine, San Juan City Hospital, San Juan, PR 00928, USA.
Case Reports in Rheumatology
|January 25, 2013
Summary
Cocaine adulterated with levamisole can cause necrotizing vasculitis. This study reports three cases of levamisole-induced vasculitis with positive antineutrophil cytoplasmic antibodies (ANCAs) in the Caribbean.
Area of Science:
- Toxicology
- Rheumatology
- Public Health
Background:
- Cocaine abuse is prevalent, with illicit drug markets often adulterating products to increase profit and appeal.
- Levamisole, a former chemotherapeutic and immunomodulator, is frequently detected in seized cocaine, with the US Drug Enforcement Agency reporting its presence in 70% of cocaine at US borders.
- Adulterated cocaine use is associated with severe health consequences, notably necrotizing vasculitis.
Purpose of the Study:
- To describe three cases of necrotizing vasculitis linked to cocaine use.
- To investigate the association between cocaine-induced vasculitis and antineutrophil cytoplasmic antibodies (ANCAs).
- To report the first cases of cocaine-induced vasculitis in the Caribbean region.
Main Methods:
- Case series reporting on three patients presenting with symptoms suggestive of vasculitis.
- Clinical evaluation including laboratory tests to assess for antineutrophil cytoplasmic antibodies (ANCAs).
- Review of patient history to confirm cocaine use and identify potential adulterants.
Main Results:
- Three patients presented with necrotizing vasculitis.
- All three patients tested positive for antineutrophil cytoplasmic antibodies (ANCAs).
- The vasculitis was strongly suspected to be induced by the use of levamisole-adulterated cocaine.
Conclusions:
- Levamisole-adulterated cocaine use can trigger necrotizing vasculitis.
- ANCAs positivity is associated with this form of cocaine-induced vasculitis.
- These findings highlight a significant public health issue in the Caribbean, requiring increased awareness and diagnostic consideration.
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