A case of levamisole-induced systemic vasculitis and cocaine-induced midline destructive lesion: a case report

J Clin Rheumatol. 2011 Jun;17(4):197-200. doi: 10.1097/RHU.0b013e31821cb9d5.

Abstract

We describe a case of antineutrophil cytoplasmic antibody-positive vasculitis from levamisole-tainted cocaine with concomitant cocaine-induced midline destructive lesions of the palate and nasal septum. The diagnosis was confirmed after extensive clinical, laboratory, pathologic, and radiographic testing. Timely recognition of this clinical entity is critical to avoid misdiagnosis and unnecessary treatment with potentially harmful cytotoxic agents. Given the high rate of levamisole contamination within the nation's cocaine supply, clinicians should be alerted to this emerging health threat.

Publication types

  • Case Reports

MeSH terms

  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / chemically induced*
  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / diagnosis
  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / drug therapy
  • Antibodies, Antineutrophil Cytoplasmic / blood
  • Biopsy
  • Cocaine / adverse effects*
  • Drug Contamination*
  • Glucocorticoids / therapeutic use
  • Humans
  • Levamisole / adverse effects*
  • Male
  • Middle Aged
  • Mouth Diseases / chemically induced*
  • Mouth Diseases / diagnosis
  • Mouth Diseases / drug therapy
  • Nose Diseases / chemically induced*
  • Nose Diseases / diagnosis
  • Nose Diseases / drug therapy
  • Palate
  • Prednisone / therapeutic use
  • Skin / pathology
  • Skin Diseases, Vascular / chemically induced*
  • Skin Diseases, Vascular / diagnosis
  • Skin Diseases, Vascular / drug therapy
  • Treatment Outcome

Substances

  • Antibodies, Antineutrophil Cytoplasmic
  • Glucocorticoids
  • Levamisole
  • Cocaine
  • Prednisone