title: Levamisole-contaminated cocaine: a hairy affair.
abstract: Levamisole-contaminated cocaine can induce severe systemic vasculitis. The diagnosis can be challenging, especially when substance abuse is uncertain. We present the case of a 42-year-old woman suffering from vasculitis due to levamisole-contaminated cocaine, who persistently denied substance abuse. Symptoms included ulcerating skin lesions, arthralgia and myalgia, and the occurrence of an ileal intussusception. The definitive diagnosis was made using hair testing for toxins. She recovered through cocaine abstinence, but re-exposure resulted in a severe relapse with glomerulonephritis. Importantly, at time of the relapse, the patient became positive for both myeloperoxidase-antineutrophil cytoplasmic antibody (ANCA) and proteinase 3-ANCA. Cocaine-levamisole-induced vasculitis poses a great clinical challenge. The proper diagnostic strategy and therapy is still controversial. We highlight our diagnostic and therapeutic considerations, including hair testing for definitive proof of exposure.
authors: Department of Internal Medicine, Sint Franciscus Gasthuis, Rotterdam, The Netherlands.
authors: Tjeerd
authors: http://orcid.org/0000-0003-3085-603X
authors: T
authors: van der Veer
authors: Department of Toxicology, Maastricht University, Maastricht, The Netherlands.
authors: Ed
authors: E
authors: Pennings
authors: SFVG Academy, Sint Franciscus Vlietland Groep, Rotterdam, the Netherlands Clinical and Experimental Immunology, Maastricht University, Maastricht, the Netherlands.
authors: J W Cohen
authors: JW
authors: Tervaert
authors: Department of Rheumatology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands.
authors: Lindy-Anne
authors: LA
authors: Korswagen
mesh_terms: D000276:Adjuvants, Immunologic / Q000009:adverse effects / Q000378:metabolism; D000328:Adult; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000378:metabolism*; D003042:Cocaine / Q000008:administration & dosage; D019970:Cocaine-Related Disorders / Q000150:complications; D004340:Drug Contamination; D005260:Female; D005921:Glomerulonephritis / Q000139:chemically induced; D006197:Hair / Q000378:metabolism*; D006801:Humans; D007978:Levamisole / Q000009:adverse effects* / Q000378:metabolism; D009195:Peroxidase / Q000378:metabolism; D012008:Recurrence; D014657:Vasculitis / Q000139:chemically induced*
chemical_list: D000276:Adjuvants, Immunologic; D019268:Antibodies, Antineutrophil Cytoplasmic; D007978:Levamisole; D009195:Peroxidase; D003042:Cocaine