title: Necrotizing and crescentic glomerulonephritis with membranous nephropathy in a patient exposed to levamisole-adulterated cocaine.
abstract: Levamisole is an antihelminthic agent widely used as an adulterant of illicit cocaine recently implicated as a cause of antineutrophil cytoplasmic antibody (ANCA)-associated microscopic polyangiitis in cocaine abusers. An isolated case of membranous nephropathy (MN) associated with levamisole exposure has also been reported. We report the first case, to our knowledge, of a patient with both microscopic polyangiitis manifest as a pauci-immune necrotizing and crescentic glomerulonephritis and concurrent MN in the setting of chronic cocaine abuse and presumed levamisole exposure, raising the hypothesis that levamisole was the causative agent in the development of this rare dual glomerulopathy.
authors.affiliation: Department of Medicine, Service of Nephrology , Azienda Ospedaliera Papa Giovanni XXIII , Bergamo , Italy.
authors.forename: Camillo
authors.initials: C
authors.lastname: Carrara
authors.affiliation: Department of Medicine, Service of Nephrology , Aurora Kidney , Anchorage, AK , USA.
authors.forename: Stefano
authors.initials: S
authors.lastname: Emili
authors.affiliation: Department of Pathology , University of Washington Medical Center , Seattle, WA , USA.
authors.forename: Mercury
authors.initials: M
authors.lastname: Lin
authors.affiliation: Department of Pathology , University of Washington Medical Center , Seattle, WA , USA.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Alpers
keywords: antineutrophil cytoplasmic antibody (ANCA); kidney biopsy; levamisole; membranous nephropathy (MN)