title: Systemic Levamisole-Induced Vasculitis in a Cocaine User without Cutaneous Findings: A Consideration in Diagnosis.
abstract: Levamisole is a known immunomodulating agent frequently used as a cutting agent in cocaine consumed in the United States today. Numerous cases of anti-neutrophil cytoplasmic antibody (ANCA) vasculitis connected with the use of levamisole-adulterated cocaine have previously been reported in the literature, classically characterized by a retiform purpuric rash. We report a case of a crack-cocaine user without cutaneous abnormalities who developed ANCA-associated glomerulonephritis that progressed to renal failure. This case demonstrates the difficulties in solidifying the diagnosis of levamisole-induced vasculitis in the absence of cutaneous findings and the need to pursue more testing to establish causality in ANCA-associated vasculitis that has potential for severe end-organ damage in patients who continue to use cocaine.
authors.affiliation: Department of Medicine, Emory University, Atlanta, GA 30308, USA.
authors.forename: Gillian G
authors.initials: GG
authors.lastname: Baptiste
authors.affiliation: Department of Medicine, Emory University, Atlanta, GA 30308, USA.
authors.forename: Anastasia-Stefania
authors.initials: AS
authors.lastname: Alexopoulos
authors.affiliation: Division of Renal Medicine, Department of Medicine, Emory University, Atlanta, GA 30308, USA.
authors.forename: Tahsin
authors.initials: T
authors.lastname: Masud
authors.affiliation: Division of Hospital Medicine, Department of Medicine, Emory University, Atlanta, GA 30308, USA.
authors.forename: Joanna M
authors.initials: JM
authors.lastname: Bonsall