title: ANCA Associated Vasculitis Secondary to Levamisole-Adultered Cocaine with Associated Membranous Nephropathy: A Case Series.
abstract: BACKGROUND
  Cocaine is a risk factor for acute kidney injury and chronic kidney disease with progression to end-stage renal disease. Levamisole is an adulterant that is added to cocaine to enhance its euphoric effects. Levamisole-adulterated cocaine (LAC) is associated with the distinct clinical syndromes of agranulocytosis, leukocytoclastic vasculitis, cocaine-induced midline destructive lesions (CIMDL), and ANCA-associated vasculitis (AAV) with pauci-immune necrotizing glomerulonephritis.
  
  
  METHODS
  We reviewed all cases of AAV secondary to LAC at our institution.
  
  
  RESULTS
  We report 3 cases of AAV secondary to LAC and associated membranous nephropathy (MN). The first and second cases are concurrent AAV secondary to LAC and associated MN while the third case involves the development of MN after AAV secondary to LAC.
  
  
  CONCLUSIONS
  Clinicians should be aware of this novel association of LAC with MN.
authors.affiliation: Department of Medicine, University of Manitoba, Winnipeg, MB, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Collister
authors.forename: Christie
authors.initials: C
authors.lastname: Sathianathan
authors.forename: Krista
authors.initials: K
authors.lastname: Ryz
authors.forename: Martin
authors.initials: M
authors.lastname: Karpinski
authors.forename: Keevin
authors.initials: K
authors.lastname: Bernstein
authors.forename: Ian W
authors.initials: IW
authors.lastname: Gibson
mesh_terms: D000328:Adult; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000150:complications* / Q000175:diagnosis; D001706:Biopsy; D001794:Blood Pressure; D059350:Chronic Pain / Q000150:complications; D003042:Cocaine / Q000009:adverse effects*; D004340:Drug Contamination; D005921:Glomerulonephritis / Q000473:pathology; D015433:Glomerulonephritis, Membranous / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000139:chemically induced / Q000150:complications; D007978:Levamisole / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011693:Purpura / Q000139:chemically induced; D014657:Vasculitis / Q000473:pathology; D018366:Vasculitis, Leukocytoclastic, Cutaneous
chemical_list: D007978:Levamisole; D003042:Cocaine