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Cocaine-induced ANCA-associated renal disease: a case-based review

  • Fabian LötscherEmail author
  • Martin Krusche
  • Nikolas Ruffer
  • Torsten Kubacki
  • Fermin Person
  • Ina Kötter
Cases with a Message

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 

Notes

Author contributions

FL and MK share the first authorship and equally contributed to the draft of the manuscript. FL and NR performed the review of the literature. TK and IK reviewed the manuscript. FP provided and commented on the histopathologic examination. All the authors reviewed the draft and provided comments for change. All authors approved the final manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

296_2019_4410_MOESM1_ESM.xlsx (39 kb)
Supplementary material 1 (XLSX 39 kb)
296_2019_4410_MOESM2_ESM.docx (53 kb)
Supplementary material 2 (DOCX 53 kb)
296_2019_4410_MOESM3_ESM.docx (33 kb)
Supplementary material 3 (DOCX 32 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Asklepios Klinik Altona, Rheumatologie, Klinische Immunologie NephrologieHamburgGermany
  2. 2.Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité MitteBerlinGermany
  3. 3.Universitätsspital Basel, Institut für Medizinische Genetik und PathologieBaselSwitzerland

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