Vasculitis associated with levamisole and circulating autoantibodies.

Laux-End, R; Inaebnit, D; Gerber, H A; Mg, Bianchetti

doi:10.1136/adc.75.4.355-b

Cited by 38 publications

(27 citation statements)

References 3 publications

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“…It is known to induce circulating autoantibodies (8). These effects on innate and adaptive immune responses may explain its propensity to induce autoimmunity and vasculitis.…”

Section: Discussionmentioning

confidence: 99%

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Contaminated Cocaine and Antineutrophil Cytoplasmic Antibody-Associated Disease

McGrath

Isakova

Rennke

et al. 2011

Clinical Journal of the American Society of Nephrology

165

151

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SummaryBackground and objectives 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 2009and 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.Results 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. ConclusionsWe 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.

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“…It is known to induce circulating autoantibodies (8). These effects on innate and adaptive immune responses may explain its propensity to induce autoimmunity and vasculitis.…”

Section: Discussionmentioning

confidence: 99%

“…It was voluntarily withdrawn from the US market in 2000 due to its side-effect profile, which includes idiosyncratic agranulocytosis and the development of vasculitic lesions with prolonged exposure (7)(8)(9). Agranulocytosis was observed at rates of 2.5 to 13% in patients treated with moderate to high doses for protracted periods (10).…”

Section: Introductionmentioning

confidence: 99%

Contaminated Cocaine and Antineutrophil Cytoplasmic Antibody-Associated Disease

McGrath

Isakova

Rennke

et al. 2011

Clinical Journal of the American Society of Nephrology

165

151

View full text Add to dashboard Cite

show abstract

“…Reports exist describing cutaneous vasculitis (13,14) and the presence of autoantibodies, including ANCAs (15,16), in patients exposed to levamisole. Levamisole was withdrawn from the market in the United States in 2000 because of cases of treatment-associated agranulocytosis.…”

Section: Drugs Associated With Aavmentioning

confidence: 99%

Drug-Induced Glomerular Disease

Hogan

Markowitz²,

Radhakrishnan

2015

Clinical Journal of the American Society of Nephrology

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Drug-induced autoimmune disease was initially described decades ago, with reports of vasculitis and a lupus-like syndrome in patients taking hydralazine, procainamide, and sulfadiazine. Over the years, multiple other agents have been linked to immune-mediated glomerular disease, often with associated autoantibody formation. Certain clinical and laboratory features may distinguish these entities from their idiopathic counterparts, and making this distinction is important in the diagnosis and management of these patients. Here, drug-induced, ANCA-associated vasculitis, drug-induced lupus, and drug-associated membranous nephropathy are reviewed.

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“…Immunological abnormalities are a constant feature. Laboratory features such as perinuclear antineutrophil cytoplasmic in high titers [16,17] and lupus anticoagulant [5,14] appeared in our patient without positive specificities, although different antigen targets have been reported [17]. Rongoletti14 established the induction of such antibodies, as well as antiphospholipid antibodies in 4 patients who were negative before levamisol exposure.…”

Section: Discussionmentioning

confidence: 99%

“…Levamisol induced vasculitis was first reported simultaneously in 1978 in two women treated for rheumatoid arthritis [1,2]. Subsequent reports in children treated for nephrotic syndrome, and adults treated for multiple autoimmune conditions including vitiligo, appeared shortly after [3][4][5]. It was removed from the US market in 2000 because of the common occurrence of agranulocytosis6.…”

Section: Introductionmentioning

confidence: 99%