title: Membranous nephropathy with crescents associated with levamisole-induced MPO-ANCA vasculitis.
abstract: ANCA-associated vasculitis (AAV) is the most common cause of crescentic rapidly progressive glomerulonephritis (GN). Levamisole used as an adulterant in cocaine is increasingly recognized as a cause of AAV. We report the case of a 50 year old woman with atypical anti-MPO AAV associated with cocaine use and exposure to levamisole. In addition to the clinical and pathologic findings of crescentic GN, the patient also had biopsy evidence of secondary membranous nephropathy (MN). Although AAV and MN have been reported previously in the same patient and both have been induced by drug exposures, this is the first report of MN in a patient with AAV likely induced by levamisole. We suggest that MPO can cause both pauci-immune vasculitis and secondary membranous nephropathy in some cases, as in cases of levamisole-adulterated cocaine use.
authors.affiliation: Division of Nephrology, University of Arizona Medical Center, Tucson, AZ, United States. Electronic address: irfanmoinuddin@yahoo.com.
authors.forename: Irfan
authors.initials: I
authors.lastname: Moinuddin
authors.affiliation: Division of Nephrology, University of Arizona Medical Center, Tucson, AZ, United States. Electronic address: mmadhrira@swkidney.com.
authors.forename: Machaiah
authors.initials: M
authors.lastname: Madhrira
authors.affiliation: Department of Pathology, University of Arizona Medical Center, Tucson, AZ, United States. Electronic address: erikab@pathology.arizona.edu.
authors.forename: Erika
authors.initials: E
authors.lastname: Bracamonte
authors.affiliation: Division of Nephrology, University of Arizona Medical Center, Tucson, AZ, United States. Electronic address: bijint@deptofmed.arizona.edu.
authors.forename: Bijin
authors.initials: B
authors.lastname: Thajudeen
authors.affiliation: Division of Nephrology, University of Arizona Medical Center, Tucson, AZ, United States. Electronic address: asussman@deptofmed.arizona.edu.
authors.forename: Amy
authors.initials: A
authors.lastname: Sussman
mesh_terms: D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000139:chemically induced* / Q000150:complications / Q000473:pathology; D003042:Cocaine / Q000009:adverse effects*; D004340:Drug Contamination; D005260:Female; D005921:Glomerulonephritis / Q000150:complications* / Q000473:pathology; D015433:Glomerulonephritis, Membranous / Q000150:complications* / Q000473:pathology; D006801:Humans; D007668:Kidney / Q000473:pathology; D007978:Levamisole / Q000009:adverse effects*; D008875:Middle Aged
chemical_list: D007978:Levamisole; D003042:Cocaine
keywords: Crescentic; Glomerulonephritis; Levamisole; Membranous; Pauciimmune; Vasculitis