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Cocaine-induced ANCA-associated renal disease: a case-based review.
Rheumatol Int. 2019 Nov; 39(11):2005-2014.RI

Abstract

Idiopathic antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) are a group of diseases that are often difficult to diagnose due to the wide range of clinical manifestations. Notably, renal involvement is a serious organ complication, which usually requires intensive immunosuppressive therapy and is prone to recurrence. In recent years, there has been some progress regarding the understanding of the pathogenesis of the diseases. It has been shown that both cocaine and levamisole, which is a common adulterant of cocaine, can trigger the formation of ANCAs and lead to the corresponding symptoms. We report two cases of AAV with different renal manifestations associated with cocaine consumption. Furthermore, we performed a review of the literature to identify, characterize and describe histologically documented cases of renal involvement in AAV, related to cocaine abuse. Cocaine/levamisole-induced vasculitis may, therefore, mimic idiopathic AAV. Although the detection of ANCA and anti-PR3 (proteinase 3, PR3) as well as anti-MPO antibodies (myeloperoxidase, MPO) are the serological hallmark of idiopathic AAV, certain clinical- and antibody constellations should lead to consideration of illicit drugs as inductors of the disease. Especially in young patients, certain serologic constellations (e.g., PR3 and MPO double positivity, positive antinuclear antibodies, low complement level, and positive testing for antiphospholipid antibodies), skin involvement, musculoskeletal symptoms and hematologic (anemia, leukopenia) affections should prompt testing for cocaine and levamisole consumption via urine drug testing. Treatment includes both immunosuppressive approaches and drug cessation but is difficult since many patients continue cocaine consumption.

Authors+Show Affiliations

Asklepios Klinik Altona, Rheumatologie, Klinische Immunologie Nephrologie, Paul-Ehrlich-Strasse 1, 22763, Hamburg, Germany. fabu99@gmx.ch.Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany.Asklepios Klinik Altona, Rheumatologie, Klinische Immunologie Nephrologie, Paul-Ehrlich-Strasse 1, 22763, Hamburg, Germany.Asklepios Klinik Altona, Rheumatologie, Klinische Immunologie Nephrologie, Paul-Ehrlich-Strasse 1, 22763, Hamburg, Germany.Universitätsspital Basel, Institut für Medizinische Genetik und Pathologie, Schönbeinstrasse 40, 4031, Basel, Switzerland.Asklepios Klinik Altona, Rheumatologie, Klinische Immunologie Nephrologie, Paul-Ehrlich-Strasse 1, 22763, Hamburg, Germany.

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

31401698

Citation

Lötscher, Fabian, et al. "Cocaine-induced ANCA-associated Renal Disease: a Case-based Review." Rheumatology International, vol. 39, no. 11, 2019, pp. 2005-2014.
Lötscher F, Krusche M, Ruffer N, et al. Cocaine-induced ANCA-associated renal disease: a case-based review. Rheumatol Int. 2019;39(11):2005-2014.
Lötscher, F., Krusche, M., Ruffer, N., Kubacki, T., Person, F., & Kötter, I. (2019). Cocaine-induced ANCA-associated renal disease: a case-based review. Rheumatology International, 39(11), 2005-2014. https://doi.org/10.1007/s00296-019-04410-9
Lötscher F, et al. Cocaine-induced ANCA-associated Renal Disease: a Case-based Review. Rheumatol Int. 2019;39(11):2005-2014. PubMed PMID: 31401698.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cocaine-induced ANCA-associated renal disease: a case-based review. AU - Lötscher,Fabian, AU - Krusche,Martin, AU - Ruffer,Nikolas, AU - Kubacki,Torsten, AU - Person,Fermin, AU - Kötter,Ina, Y1 - 2019/08/10/ PY - 2019/05/09/received PY - 2019/07/31/accepted PY - 2019/8/12/pubmed PY - 2020/4/28/medline PY - 2019/8/12/entrez KW - ANCA-associated vasculitis KW - Cocaine KW - Glomerulonephritis KW - Levamisole SP - 2005 EP - 2014 JF - Rheumatology international JO - Rheumatol Int VL - 39 IS - 11 N2 - Idiopathic antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) are a group of diseases that are often difficult to diagnose due to the wide range of clinical manifestations. Notably, renal involvement is a serious organ complication, which usually requires intensive immunosuppressive therapy and is prone to recurrence. In recent years, there has been some progress regarding the understanding of the pathogenesis of the diseases. It has been shown that both cocaine and levamisole, which is a common adulterant of cocaine, can trigger the formation of ANCAs and lead to the corresponding symptoms. We report two cases of AAV with different renal manifestations associated with cocaine consumption. Furthermore, we performed a review of the literature to identify, characterize and describe histologically documented cases of renal involvement in AAV, related to cocaine abuse. Cocaine/levamisole-induced vasculitis may, therefore, mimic idiopathic AAV. Although the detection of ANCA and anti-PR3 (proteinase 3, PR3) as well as anti-MPO antibodies (myeloperoxidase, MPO) are the serological hallmark of idiopathic AAV, certain clinical- and antibody constellations should lead to consideration of illicit drugs as inductors of the disease. Especially in young patients, certain serologic constellations (e.g., PR3 and MPO double positivity, positive antinuclear antibodies, low complement level, and positive testing for antiphospholipid antibodies), skin involvement, musculoskeletal symptoms and hematologic (anemia, leukopenia) affections should prompt testing for cocaine and levamisole consumption via urine drug testing. Treatment includes both immunosuppressive approaches and drug cessation but is difficult since many patients continue cocaine consumption. SN - 1437-160X UR - https://news.unboundmedicine.com/medline/citation/31401698/Cocaine-induced_ANCA-associated_renal_disease:_a_case-based_review. DB - PRIME DP - Unbound Medicine ER -