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Félix Blaison1, Déborah Faganello1, Camille Goigoux1

  • 1Service de médecine interne et immunologie clinique, hôpital Saint-André, CHU de Bordeaux, 1 Rue Jean Burguet, 33000 Bordeaux, France.

La Revue De Medecine Interne
|July 15, 2020
PubMed
Summary
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Cocaine-induced midline destructive lesions (CIMDL) can mimic ANCA-associated vasculitis. This case highlights CIMDL presenting with positive anti-Proteinase 3 ANCA, emphasizing diagnostic challenges.

Area of Science:

  • Rheumatology
  • Toxicology
  • Pathology

Background:

  • Cocaine use presents diverse complications, often mimicking systemic autoimmune diseases like Antineutrophil Cytoplasmic Antibody (ANCA)-associated vasculitis.
  • Distinguishing Cocaine-Induced Midline Destructive Lesions (CIMDL) from Granulomatosis with Polyangiitis (GPA) is crucial for accurate diagnosis and management.

Observation:

  • A 42-year-old male, a regular cocaine user, presented with a destructive centrofacial process without other Ear, Nose, and Throat (ENT) involvement.
  • Laboratory tests revealed positive ANCA with a perinuclear pattern and anti-Proteinase 3 (PR3) specificity.

Findings:

  • Despite positive anti-PR3 ANCA, histological examination lacked definitive evidence for GPA.
  • A diagnosis of CIMDL was established due to the unusual immunologic profile in the context of cocaine use and destructive midline lesions.
Keywords:
ANCACocaineCocaine induced midline destructive lesionsCocaïneNasal septum perforationPerforation du septum nasal

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Implications:

  • CIMDL is a distinct clinical entity characterized by destructive centrofacial lesions resulting from intranasal cocaine abuse.
  • The condition is often associated with positive perinuclear ANCA (p-ANCA), frequently exhibiting anti-HNE and anti-PR3 specificity, posing diagnostic challenges.
  • Recognition of CIMDL is vital to avoid misdiagnosis of autoimmune vasculitis and ensure appropriate patient care.