title: Rheumatic manifestations of cocaine use.
abstract: OBJECTIVE
  Cocaine use is associated with several rheumatic syndromes. This review summarizes these clinical manifestations and highlights recent developments linked to levamisole-adulterated cocaine.
  
  
  RESULTS
  Cocaine use has been linked to several distinctive syndromes that can be difficult to distinguish from idiopathic rheumatic diseases. These disorders can range in severity from purely cosmetic damage to organ and/or life-threatening disease that includes sinonasal destruction and vasculitis. Many of these illnesses are associated with antineutrophil cytoplasmic antibodies (cytoplasmic, perinuclear and atypical perinuclear patterns). With the recent introduction of levamisole as a cocaine adulterant, a newly reported syndrome has emerged that is associated with neutropenia, retiform purpura with cutaneous necrosis and autoantibodies consisting of high-titre perinuclear antineutrophil cytoplasmic antibodies (p-ANCAs) with specificities for 'atypical' antigens.
  
  
  CONCLUSIONS
  Cocaine use is associated with clinical syndromes that closely mimic other primary rheumatic diseases. Given the high prevalence of cocaine use and its adulteration with levamisole, clinicians should be familiar with these rheumatic manifestations in order to avoid misdiagnosis and unnecessary treatment with potentially toxic therapies.
authors.affiliation: Department of Medicine University of California San Francisco, Division of Rheumatology, San Francisco General Hospital, San Francisco, California 94110, USA. jonathan.graf@ucsf.edu
authors.forename: Jonathan
authors.initials: J
authors.lastname: Graf
mesh_terms: D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000139:chemically induced / Q000175:diagnosis; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000032:analysis; D019970:Cocaine-Related Disorders / Q000150:complications* / Q000175:diagnosis; D003937:Diagnosis, Differential; D004340:Drug Contamination; D006801:Humans; D007978:Levamisole / Q000633:toxicity; D012216:Rheumatic Diseases / Q000139:chemically induced* / Q000175:diagnosis; D014657:Vasculitis / Q000139:chemically induced / Q000175:diagnosis
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D007978:Levamisole