Renal Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA.
Clin J Am Soc Nephrol. 2011 Dec;6(12):2799-805. doi: 10.2215/CJN.03440411. Epub 2011 Oct 6.
Approximately 70% of illicit cocaine consumed in the United States is contaminated with levamisole. Most commonly used as a veterinary antihelminthic agent, levamisole is a known immunomodulating agent. Prolonged use in humans has been associated with cutaneous vasculitis and agranulocytosis. We describe the development of a systemic autoimmune disease associated with antineutrophil cytoplasmic antibodies (ANCA) in cocaine users. This complication appears to be linked to combined cocaine and levamisole exposure.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Cases were identified between March 2009 and November 2010 at Massachusetts General Hospital's ANCA laboratory. Cocaine exposure was identified from patient history in all cases. Medical records were reviewed for clinical presentation and for laboratory and diagnostic evaluation.
Thirty cases of ANCA positivity associated with cocaine ingestion were identified. All had antimyeloperoxidase antibodies and 50% also had antiproteinase 3 antibodies. Complete clinical and laboratory data were available for 18 patients. Arthralgia (83%) and skin lesions (61%) were the most frequent complaints at presentation. Seventy-two percent of patients reported constitutional symptoms, including fever, night sweats, weight loss, or malaise. Four patients had biopsy-proven vasculitis. Two cases of acute kidney injury and three cases of pulmonary hemorrhage occurred. From the entire cohort of 30, two cases were identified during the first 3 months of our study period and nine cases presented during the last 3 months.
We describe an association between the ingestion of levamisole-contaminated cocaine and ANCA-associated systemic autoimmune disease. Our data suggest that this is a potentially life-threatening complication of cocaine use.
在美国，大约 70%的非法可卡因消费都受到了左旋咪唑的污染。左旋咪唑最常被用作兽医驱虫剂，是一种已知的免疫调节剂。在人类中长期使用会导致皮肤血管炎和粒细胞缺乏症。我们描述了一种与抗中性粒细胞胞质抗体（ANCA）相关的与可卡因使用者相关的系统性自身免疫疾病的发展。这种并发症似乎与可卡因和左旋咪唑的联合暴露有关。
设计、地点、参与者和测量方法：2009 年 3 月至 2010 年 11 月期间，在马萨诸塞州总医院的 ANCA 实验室鉴定了病例。在所有病例中，根据患者病史确定可卡因暴露。回顾病历以评估临床表现以及实验室和诊断评估。
确定了 30 例与可卡因摄入相关的 ANCA 阳性病例。所有患者均具有抗髓过氧化物酶抗体，50%的患者还具有抗蛋白酶 3 抗体。18 名患者的完整临床和实验室数据可用。关节炎（83%）和皮肤病变（61%）是就诊时最常见的症状。72%的患者报告有全身症状，包括发热、盗汗、体重减轻或不适。有 4 例患者经活检证实有血管炎。有 2 例急性肾损伤和 3 例肺出血发生。在整个 30 例患者队列中，有 2 例在我们研究的前 3 个月期间确定，9 例在最后 3 个月期间出现。
我们描述了左旋咪唑污染可卡因摄入与 ANCA 相关的系统性自身免疫疾病之间的关联。我们的数据表明，这是可卡因使用的潜在危及生命的并发症。
