van der Veer Tjeerd, Pennings Ed, Tervaert J W Cohen, Korswagen Lindy-Anne
Department of Internal Medicine, Sint Franciscus Gasthuis, Rotterdam, The Netherlands.
Department of Toxicology, Maastricht University, Maastricht, The Netherlands.
BMJ Case Rep. 2015 Aug 26;2015:bcr2015210970. doi: 10.1136/bcr-2015-210970.
Levamisole-contaminated cocaine can induce severe systemic vasculitis. The diagnosis can be challenging, especially when substance abuse is uncertain. We present the case of a 42-year-old woman suffering from vasculitis due to levamisole-contaminated cocaine, who persistently denied substance abuse. Symptoms included ulcerating skin lesions, arthralgia and myalgia, and the occurrence of an ileal intussusception. The definitive diagnosis was made using hair testing for toxins. She recovered through cocaine abstinence, but re-exposure resulted in a severe relapse with glomerulonephritis. Importantly, at time of the relapse, the patient became positive for both myeloperoxidase-antineutrophil cytoplasmic antibody (ANCA) and proteinase 3-ANCA. Cocaine-levamisole-induced vasculitis poses a great clinical challenge. The proper diagnostic strategy and therapy is still controversial. We highlight our diagnostic and therapeutic considerations, including hair testing for definitive proof of exposure.
受左旋咪唑污染的可卡因可引发严重的系统性血管炎。诊断颇具挑战性，尤其是在药物滥用情况不明时。我们报告一例42岁女性因受左旋咪唑污染的可卡因导致血管炎，该患者一直否认药物滥用。症状包括溃疡性皮肤病变、关节痛和肌痛，以及回肠套叠的发生。通过毛发毒素检测做出了明确诊断。她通过戒除可卡因康复，但再次接触导致严重复发并伴有肾小球肾炎。重要的是，复发时患者髓过氧化物酶抗中性粒细胞胞浆抗体（ANCA）和蛋白酶3 - ANCA均呈阳性。可卡因 - 左旋咪唑诱发的血管炎带来了巨大的临床挑战。恰当的诊断策略和治疗仍存在争议。我们强调了我们的诊断和治疗考量，包括通过毛发检测以明确接触证据。
