Department of Internal Medicine, Section of Rheumatology, LSU Health Sciences, New Orleans, Louisiana.
Am J Med Sci. 2013 Nov;346(5):430-1. doi: 10.1097/MAJ.0b013e3182972014.
It has been recognized that nasal cocaine abuse can induce midline destructive lesions that can mimic different disorders, including small-vessel vasculitis. The authors reported 2 cases of patients referred to the rheumatology clinic with a previous diagnosis of granulomatosis with polyangiitis (Wegener's granulomatosis), presenting with chronic perforation in the palate, refractory to immunosuppressant therapy. In both patients, laboratory investigation revealed antineutrophil cytoplasmic antibody positivity. A differential diagnosis between cocaine-induced midline destructive lesions and granulomatosis with polyangiitis is also difficult to establish because of the presence of antineutrophil cytoplasmic antibody in both disorders. Given the high prevalence of cocaine use, awareness of this mimic is essential to avoid a misdiagnosis and the use of unnecessary and potential toxic therapies.
人们已经认识到，鼻内可卡因滥用会导致中线破坏性病变，这些病变可能模仿包括小血管血管炎在内的不同疾病。作者报告了 2 例患者，他们因先前诊断的肉芽肿性多血管炎（韦格纳肉芽肿）而被转至风湿病诊所，表现为腭部慢性穿孔，对免疫抑制剂治疗无反应。在这 2 例患者中，实验室检查均显示抗中性粒细胞胞浆抗体阳性。由于这两种疾病均存在抗中性粒细胞胞浆抗体，因此在鉴别诊断可卡因诱导的中线破坏性病变和肉芽肿性多血管炎时也很困难。鉴于可卡因使用率较高，了解这种模仿疾病对于避免误诊和使用不必要且潜在有毒的治疗方法至关重要。
