Cocaine-induced ANCA-associated renal disease: a case-based review
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Rheumatology International https://doi.org/10.1007/s00296-019-04410-9
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CASES WITH A MESSAGE
Cocaine‑induced ANCA‑associated renal disease: a case‑based review Fabian Lötscher1 · Martin Krusche2 · Nikolas Ruffer1 · Torsten Kubacki1 · Fermin Person3 · Ina Kötter1 Received: 9 May 2019 / Accepted: 31 July 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract Idiopathic antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) are a group of diseases that are often difficult to diagnose due to the wide range of clinical manifestations. Notably, renal involvement is a serious organ complication, which usually requires intensive immunosuppressive therapy and is prone to recurrence. In recent years, there has been some progress regarding the understanding of the pathogenesis of the diseases. It has been shown that both cocaine and levamisole, which is a common adulterant of cocaine, can trigger the formation of ANCAs and lead to the corresponding symptoms. We report two cases of AAV with different renal manifestations associated with cocaine consumption. Furthermore, we performed a review of the literature to identify, characterize and describe histologically documented cases of renal involvement in AAV, related to cocaine abuse. Cocaine/levamisole-induced vasculitis may, therefore, mimic idiopathic AAV. Although the detection of ANCA and anti-PR3 (proteinase 3, PR3) as well as anti-MPO antibodies (myeloperoxidase, MPO) are the serological hallmark of idiopathic AAV, certain clinical- and antibody constellations should lead to consideration of illicit drugs as inductors of the disease. Especially in young patients, certain serologic constellations (e.g., PR3 and MPO double positivity, positive antinuclear antibodies, low complement level, and positive testing for antiphospholipid antibodies), skin involvement, musculoskeletal symptoms and hematologic (anemia, leukopenia) affections should prompt testing for cocaine and levamisole consumption via urine drug testing. Treatment includes both immunosuppressive approaches and drug cessation but is difficult since many patients continue cocaine consumption. Keywords Cocaine · Levamisole · Glomerulonephritis · ANCA-associated vasculitis
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00296-019-04410-9) contains supplementary material, which is available to authorized users. * Fabian Lötscher [email protected] Martin Krusche [email protected] Nikolas Ruffer [email protected] Torsten Kubacki [email protected] Fermin Person [email protected]
Cocaine is an illicit drug with potent stimulating effects. According to the European Monitoring Centre For Drugs And Drug Addiction (EMCDDA), in 2018 the estimated lifetime prevalence of cocaine use in adults (15–65 years) in the European Union was 5.2%, ranking second after 1
Asklepios Klinik Altona, Rheumatologie, Klinische Immunologie Nephrologie, Paul‑Ehrlich‑Strasse 1, 22763 Hamburg, Germ
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