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Cocaine- and Levamisole-Induced Vasculitis (CLIV).

Zahra Vaezi1, Afshin Amini1

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Summary

Cocaine- and levamisole-induced vasculitis (CLIV) is a severe condition affecting skin, kidneys, and lungs. Early recognition and stopping drug use are key to improving patient outcomes.

Keywords:
anca-associated vasculitiscocaine- and levamisole-induced vasculitiscrescentic glomerulonephritis (rpgn)diffuse alveolar hemorrhagevasculitis

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Area of Science:

  • Rheumatology
  • Toxicology
  • Nephrology

Background:

  • Cocaine- and levamisole-induced vasculitis (CLIV) is a specific drug-induced vasculitis.
  • It is characterized by dual antineutrophil cytoplasmic antibody (ANCA) positivity, rapidly progressive glomerulonephritis (RPGN), and diffuse alveolar hemorrhage (DAH).

Purpose of the Study:

  • To systematically review and synthesize current data on CLIV.
  • To clarify clinical presentations, diagnostic methods, and management strategies for CLIV.

Main Methods:

  • A systematic literature search was conducted on PubMed and Google Scholar (2015-2024).
  • Keywords included "levamisole-induced vasculitis," "cocaine-associated vasculitis," "dual ANCA vasculitis," "RPGN," and "DAH."
  • 18 relevant studies were included in the final analysis.

Main Results:

  • The majority of patients exhibited cutaneous, renal, and pulmonary symptoms.
  • Diagnosis involved ANCA serology (MPO, PR3), biopsy, and imaging.
  • Corticosteroids were the primary treatment; severe cases needed rituximab, cyclophosphamide, or plasmapheresis.

Conclusions:

  • Early diagnosis and cessation of cocaine and levamisole exposure significantly improve prognosis.
  • Recognizing CLIV in cocaine users with ANCA-positive vasculitis is crucial for timely intervention.