Toxics and atypical manifestations. Vasculitis associated with levamisole-adulterated cocaine. A case report

Clinical case

A 57-year-old patient with active inhaled cocaine consumption consulted for asthenia, sweating and elevated inflammatory parameters. A positive result was obtained in anti-neutrophil cytoplasmic antibodies (ANCA) type PR 3, without evidence of uptake on positron emission tomography with fluorodeoxyglucose (PET-CT). The study was completed with a renal biopsy that demonstrated a focus of acute tubular necrosis within an area of lymphoplasmacytic interstitial infiltrate with the absence of proliferative signs. The presumptive diagnosis of vasculitis associated with the consumption of toxins, cocaine adulterated with levamisole, was established.

Discussion

Since 2010, cases of levamisole-adulterated cocaine-induced vasculitis have been reported, frequently manifesting with skin lesions, the appearance of purpuric lesions on the ears being typical. The presence of renal involvement associated with pauci-immune glomerulonephritis has been described. Treatment will be abstinence from toxins; however, steroids or immunosuppressive drugs may become necessary without consensus in the clinical practice guidelines on their indication.