title: Levamisole-Adulterated Cocaine Nephrotoxicity:  Ultrastructural Features.
abstract: OBJECTIVE
  The issue of levamisole-adulterated cocaine is emerging as a rapidly growing public health concern due to an increasing number of reports describing its role in cutaneous vasculitis and agranulocytosis. Of note, levamisole is recognized as a contaminant in 69% of the cocaine used within the United States.
  
  
  METHODS
  We describe a patient who was a chronic cocaine user and developed systemic vasculitis characterized by polyarthralgia, bullous skin lesions, agranulocytosis, and antineutrophil cytoplasmic antibody-positive rapidly progressive glomerulonephritis.
  
  
  RESULTS
  The skin biopsy specimen demonstrated leukocytoclastic vasculitis. The renal biopsy specimen revealed pauci-immune necrotizing and crescentic glomerulonephritis and unusual deposits with medium electron density composed of granules, microspherules, and rare single fibrils on electron microscopy.
  
  
  CONCLUSIONS
  The electron microscopic features of levamisole-adulterated cocaine toxicity are novel findings that are presented for the first time, to our knowledge, in this report.
authors.affiliation: From the Department of Internal Medicine, University of Southern California, Los Angeles.
authors.forename: Yi-Wei Justin
authors.initials: YW
authors.lastname: Liu
authors.affiliation: Division of Nephrology.
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Mutnuri
authors.affiliation: Department of Internal Medicine.
authors.forename: Sarah Batool
authors.initials: SB
authors.lastname: Siddiqui
authors.affiliation: Department of Internal Medicine.
authors.forename: Geoff Richard
authors.initials: GR
authors.lastname: Weikle
authors.affiliation: Department of Pathology.
authors.forename: Olajumoke
authors.initials: O
authors.lastname: Oladipo
authors.affiliation: Division of Rheumatology, University of Texas Medical Branch at Galveston.
authors.forename: Niharika
authors.initials: N
authors.lastname: Ganti
authors.affiliation: Division of Nephrology.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Beach
authors.affiliation: Department of Pathology maafrouz@utmb.edu.
authors.forename: Marjan
authors.initials: M
authors.lastname: Afrouzian
mesh_terms: D000969:Antinematodal Agents / Q000009:adverse effects*; D003042:Cocaine / Q000737:chemistry*; D019970:Cocaine-Related Disorders / Q000150:complications*; D005260:Female; D005921:Glomerulonephritis / Q000139:chemically induced / Q000473:pathology; D006801:Humans; D007668:Kidney / Q000648:ultrastructure; D007978:Levamisole / Q000009:adverse effects*; D046529:Microscopy, Electron, Transmission; D008875:Middle Aged; D012867:Skin / Q000648:ultrastructure; D056647:Systemic Vasculitis / Q000139:chemically induced* / Q000473:pathology
chemical_list: D000969:Antinematodal Agents; D007978:Levamisole; D003042:Cocaine
keywords: Cocaine; Cutaneous vasculitis; Electron microscopy; Levamisole; Pauci-immune