Cocaine-induced scleroderma and scleroderma renal crisis

Area of Science:

• Nephrology
• Rheumatology
• Toxicology

Background:

• Systemic sclerosis is an autoimmune disease characterized by fibrosis and vascular abnormalities.
• Scleroderma renal crisis (SRC) is a severe complication of systemic sclerosis, presenting with accelerated hypertension and renal failure.
• Cocaine use has been anecdotally linked to the onset or unmasking of systemic sclerosis.

Observation:

• A 46-year-old male with a history of heavy cocaine abuse presented with symptoms suggestive of systemic sclerosis.
• The patient's presentation included accelerated hypertension and rapidly progressive renal failure, consistent with scleroderma renal crisis.
• The clinical course indicated that cocaine abuse likely unmasked subclinical systemic sclerosis and precipitated SRC.

Findings:

• This case report details the precipitation of scleroderma renal crisis in a patient with a history of significant cocaine abuse.
• The findings suggest that cocaine can act as a trigger, unmasking underlying systemic sclerosis in susceptible individuals.
• The patient experienced rapid onset of hypertension and renal failure following cocaine use.

Implications:

• This case underscores the importance of considering substance abuse, particularly cocaine, in the differential diagnosis of systemic sclerosis and SRC.
• Clinicians should inquire about recreational drug use in patients presenting with features of systemic sclerosis or unexplained renal crisis.
• Further research may elucidate the mechanisms by which cocaine interacts with autoimmune pathways to precipitate systemic sclerosis and SRC.