Levamisole
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Acute kidney injury secondary to vasculitis: case report A 65-year-old man developed acute kidney injury secondary to vasculitis following use of levamisole-adulterated cocaine. The man, who had history of coronary artery disease and chronic cocaine use [route and exact amount not stated], was admitted for acute kidney injury. Laboratory investigation revealed an elevated creatinine level. The fractional excretion of sodium was 2% and urinalysis showed muddy brown casts. A presumed diagnosis of acute tubular necrosis was made. During hospitalisation, he showed steady urinary output and his creatinine slightly improved. Therefore, he was discharged with outpatient follow-up. However, within a few weeks, his creatinine again rose to 3.8 mg/dL. Chest x-ray demonstrated bilateral pleural effusions. He was hospitalised again. Repeat urinalysis revealed numerous dysmorphic red blood cells. Spot urine protein/creatinine ratio was 1.7 mg/g. Subsequent analysis was significant for elevated ESR, positive myeloperoxidase antibody and elevated perinuclear antineutrophil cytoplasmic antibody titre. Renal biopsy demonstrated pauci-immune necrotising crescentic glomerulonephritis. Based on his clinical presentation and medical history, he was diagnosed with cocaine-induced vasculitis. The vasculitis was attributed to levamisole, which is quite often present as a contaminant in cocaine products [time to reaction onset not stated]. The man was treated with prednisone and rituximab. At a 6 month follow-up, his creatinine level decreased to 2.8 mg/dL and his symptoms resolved. Author comment: "This case provides a unique clinical presentation of levamisole-induced vasculitis..." "[The patient’s] only manifestation of levamisole-induced vasculitis was renal failure from glomerulonephritis." Kulkarni S. Acute kidney injury related to a chronic problem. Journal of Hospital Medicine 13 (Suppl. 1): abstr. 667, No. 4, 2018. Available from: URL: https:// www.shmabstracts.com/abstract/acute-kidney-injury-related-to-a-chronic-problem/ 803432456 [abstract] - USA
0114-9954/19/1778-0001/$14.95 Adis © 2019 Springer Nature Switzerland AG. All rights reserved
Reactions 9 Nov 2019 No. 1778
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