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A Case Report on Suspected Levamisole-Induced Pseudovasculitis
WMJ : Official Publication of the State Medical Society of Wisconsin
|November 4, 2017
Summary
Levamisole-induced pseudovasculitis mimics autoimmune vasculitis, especially in patients with a history of cocaine use and inconsistent ANCA results. High suspicion is crucial for accurate diagnosis and avoiding prolonged corticosteroid side effects.
Area of Science:
- Rheumatology
- Toxicology
- Pathology
Background:
- Levamisole, a common adulterant in cocaine, is increasingly recognized for causing a pseudovasculitis syndrome.
- Distinguishing levamisole-induced pseudovasculitis from primary vasculitides like granulomatosis with polyangiitis is clinically challenging due to overlapping symptoms and serological markers.
Observation:
- A 50-year-old male presented with bilateral pulmonary emboli and multi-organ failure, initially diagnosed with granulomatosis with polyangiitis based on positive ANCA markers (PR3, MPO, P-ANCA, C-ANCA).
- The patient's history of chronic cocaine use, skin ulcers, thrombotic events, and febrile illnesses raised suspicion for levamisole-induced pseudovasculitis.
Findings:
- Biopsy findings are critical for differentiation, with the absence of granulomas and leukocytoclasia, and the presence of vasculopathic purpura, favoring pseudovasculitis.
- Inconsistent anti-neutrophil cytoplasmic antibodies (ANCA) patterns in the context of cocaine use should prompt consideration of levamisole-induced pseudovasculitis.
Implications:
- Accurate differentiation prevents unnecessary and potentially harmful long-term corticosteroid therapy associated with granulomatosis with polyangiitis.
- Maintaining a high index of suspicion for levamisole-induced pseudovasculitis is essential for appropriate patient management and avoiding adverse effects of misdiagnosis.
