Levamisole adulterated cocaine associated ANCA vasculitis: review of literature and update on pathogenesis

Qiuyu Jin; Sam Kant; Jihad Alhariri; Duvuru Geetha

doi:10.1080/20009666.2018.1536242

Levamisole adulterated cocaine associated ANCA vasculitis: review of literature and update on pathogenesis

J Community Hosp Intern Med Perspect. 2018 Dec 11;8(6):339-344. doi: 10.1080/20009666.2018.1536242. eCollection 2018.

Authors

Qiuyu Jin¹, Sam Kant², Jihad Alhariri³, Duvuru Geetha⁴

Affiliations

¹ Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
² Department of Medicine, University of Maryland Medical Center, Baltimore, MD, USA.
³ Division of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁴ Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Abstract

Levamisole is an antihelminth drug and a common cocaine contaminant, present in an estimated 71% of cocaine samples in the US. Levamisole-contaminated cocaine has been linked to an ANCA-associated vasculitis with cutaneous, renal, and pulmonary manifestations. We report the case of a 46 year old woman with known cocaine exposure who presents with recurrent, large purpuric and maculopapular rash of the extremities and face and review existing cases of levamisole/cocaine-associated ANCA vasculitis, We summarize the clinical presentation, treatment, and outcomes of levamisole induced vasculitis. There is emerging research on pathogenesis relating to neutrophil extracellular traps (NETs). We review studies implicating role of NETs in the pathogenesis of levamisole induced vasculitis. Further research to explore the use of NETs as therapeutic targets in drug induced vasculitis is needed.

Keywords: Anti-neutrophil cytoplasmic antibody; cocaine; levimasole.

Publication types

Review