Baptiste Gillian G, Alexopoulos Anastasia-Stefania, Masud Tahsin, Bonsall Joanna M
Department of Medicine, Emory University, Atlanta, GA 30308, USA.
Division of Renal Medicine, Department of Medicine, Emory University, Atlanta, GA 30308, USA.
Case Rep Med. 2015;2015:547023. doi: 10.1155/2015/547023. Epub 2015 Oct 8.
Levamisole is a known immunomodulating agent frequently used as a cutting agent in cocaine consumed in the United States today. Numerous cases of anti-neutrophil cytoplasmic antibody (ANCA) vasculitis connected with the use of levamisole-adulterated cocaine have previously been reported in the literature, classically characterized by a retiform purpuric rash. We report a case of a crack-cocaine user without cutaneous abnormalities who developed ANCA-associated glomerulonephritis that progressed to renal failure. This case demonstrates the difficulties in solidifying the diagnosis of levamisole-induced vasculitis in the absence of cutaneous findings and the need to pursue more testing to establish causality in ANCA-associated vasculitis that has potential for severe end-organ damage in patients who continue to use cocaine.
左旋咪唑是一种已知的免疫调节剂，如今在美国常被用作掺入可卡因中的添加剂。此前文献中已报道了许多与使用掺有左旋咪唑的可卡因相关的抗中性粒细胞胞浆抗体（ANCA）血管炎病例，典型表现为网状紫癜性皮疹。我们报告一例使用快克可卡因的患者，其无皮肤异常，但发生了ANCA相关性肾小球肾炎并进展为肾衰竭。该病例表明，在没有皮肤表现的情况下确诊左旋咪唑诱导的血管炎存在困难，对于继续使用可卡因且有严重终末器官损伤风险的ANCA相关性血管炎患者，需要进行更多检测以确定因果关系。
