Levamisole abuse
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Antibody (ANCA)-associated pauci-immune glomerulonephritis: case report A 22-year-old man developed antineutrophil cytoplasmic antibody (ANCA)-associated pauci-immune glomerulonephritis following the abuse of levamisole adulterated cocaine [route and doses taken not stated]. The man was hospitalised with acute kidney injury and poorly controlled diabetes (current presentation). He reported one week history of dry cough and sore throat. Initially, his general practitioner suspected a bronchial infection, and started his treatment with azithromycin [azithromycine]. Later, as laboratory tests showed acute kidney injury, he was referred to the emergency department (current presentation). His medical history was significant for type I diabetes mellitus, Hashimoto’s thyroiditis, smoking and substance/drug abuse (abuse of 3,4-methylenedioxy-methamphetamine, amphetamines and levamisole adulterated cocaine). He had been receiving chronic treatment with insulin and levothyroxine sodium. Serum creatinine level was found to be 2.75 mg/dL corresponding to a glomerular filtration rate of 34 ml/min/1.73m2. Anamnesis showed normal kidney function two years prior to presentation. Urine analysis showed haematuria, sterile pyuria and nephrotic range proteinuria. Microscopic examination of the urinary sediment showed dysmorphic red blood cells and several red blood cell cylinders pathognomonic for glomerular bleeding due to glomerulonephritis. Further workup for the suspected glomerulonephritis showed normal complement levels and absence of antinuclear antibodies. Urine toxicology at admission was found to be positive for amphetamines only; however, he had a strong history of levamisole adulterated cocaine abuse. Eventually, renal biopsy led to the diagnosis of pauci-immune necrotising glomerulonephritis. Serology for ANCA was found to be positive, leading to the final diagnosis of ANCA-associated pauci-immune glomerulonephritis secondary to levamisole adulterated cocaine abuse [duration of treatment to reaction onset not stated]. The man’s treatment was started with rituximab and unspecified corticosteroids. Subsequently, his kidney function stabilised, but no significant improvement was noted. Vermeulen L, et al. Cocaine Consumption and Antineutrophil Cytoplasmic Antibody-associated Glomerulonephritis: A Case Report. American Journal of Forensic Medicine 803518488 and Pathology 2020: 12 Nov 2020. Available from: URL: http://doi.org/10.1097/PAF.0000000000000618
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Reactions 5 Dec 2020 No. 1833
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