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Levamisole-Adulterated Cocaine Nephrotoxicity: Ultrastructural Features
Yi-Wei Justin Liu1, Sangeeta Mutnuri2, Sarah Batool Siddiqui3
1From the Department of Internal Medicine, University of Southern California, Los Angeles.
American Journal of Clinical Pathology
|June 2, 2016
Summary
Levamisole-adulterated cocaine is a growing public health concern, linked to vasculitis and agranulocytosis. This case highlights novel electron microscopy findings in a patient with systemic vasculitis due to cocaine contamination.
Area of Science:
- Toxicology
- Dermatology
- Nephrology
Background:
- Levamisole is a common adulterant in cocaine, posing significant health risks.
- Reports link levamisole-adulterated cocaine to cutaneous vasculitis and agranulocytosis.
- This adulterant is found in a majority of cocaine used in the United States.
Observation:
- A chronic cocaine user presented with systemic vasculitis, including skin lesions and agranulocytosis.
- The patient also developed antineutrophil cytoplasmic antibody-positive rapidly progressive glomerulonephritis.
- Skin biopsy showed leukocytoclastic vasculitis; renal biopsy revealed glomerulonephritis with unusual electron microscopic deposits.
Findings:
- Electron microscopy identified novel, electron-dense granular and microspherular deposits in the renal tissue.
- These findings are associated with levamisole-adulterated cocaine toxicity.
- This is the first report to describe these specific ultrastructural features.
Implications:
- These novel findings enhance understanding of levamisole-adulterated cocaine toxicity.
- This could aid in the diagnosis of similar cases presenting with systemic vasculitis.
- Highlights the critical need for awareness and detection of cocaine adulteration in clinical practice.