Levamisole/Cocaine Induced Systemic Vasculitis and Immune Complex Glomerulonephritis.

Area of Science:

• Nephrology
• Rheumatology
• Toxicology

Background:

• Levamisole, an antihelminthic and immunomodulator, was banned by the USFDA in 1998.
• It is increasingly used to adulterate cocaine, possessing psychotropic and morphological properties.
• Adverse reactions like vasculitis, thrombocytopenia, and agranulocytosis are known, but renal involvement is uncommon.

Purpose of the Study:

• To report a rare case of ANCA-positive systemic vasculitis with biopsy-proven immune complex glomerulonephritis.
• To investigate the potential link between levamisole/cocaine adulteration and severe renal pathology.

Main Methods:

• Case presentation of a 40-year-old male with symptoms of systemic vasculitis and renal dysfunction.
• Comprehensive laboratory testing including rheumatologic workup (ANA, ANCA, myeloperoxidase antibody) and renal function tests.
• Kidney biopsy for histopathological examination and immune complex deposition analysis.

Main Results:

• The patient presented with fatigue, rash, arthralgia, oral lesions, oliguria, hematuria, dyspnea, and edema.
• Laboratory findings revealed severe anemia, azotemia, proteinuria, hypocomplementemia, and positive atypical p-ANCA with myeloperoxidase antibodies.
• Kidney biopsy confirmed immune-mediated glomerulonephritis with mesangial proliferation and IgG, IgM, and complement deposition.
• Treatment with corticosteroids and cocaine cessation improved systemic symptoms but did not restore renal function, resulting in dialysis dependence.

Conclusions:

• Levamisole adulteration in cocaine can trigger ANCA-positive systemic vasculitis and immune complex glomerulonephritis.
• Renal involvement, though uncommon, can be severe and lead to end-stage renal disease.
• This case underscores the importance of considering drug adulteration in unexplained systemic vasculitis with renal compromise.