PMID- 26311010
OWN - NLM
STAT- MEDLINE
DCOM- 20160509
LR  - 20190201
IS  - 1757-790X (Electronic)
IS  - 1757-790X (Linking)
VI  - 2015
DP  - 2015 Aug 26
TI  - Levamisole-contaminated cocaine: a hairy affair.
LID - 10.1136/bcr-2015-210970 [doi]
LID - bcr2015210970
AB  - 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.
CI  - 2015 BMJ Publishing Group Ltd.
FAU - van der Veer, Tjeerd
AU  - van der Veer T
AUID- ORCID: 0000-0003-3085-603X
AD  - Department of Internal Medicine, Sint Franciscus Gasthuis, Rotterdam, The 
      Netherlands.
FAU - Pennings, Ed
AU  - Pennings E
AD  - Department of Toxicology, Maastricht University, Maastricht, The Netherlands.
FAU - Tervaert, J W Cohen
AU  - Tervaert JW
AD  - SFVG Academy, Sint Franciscus Vlietland Groep, Rotterdam, the Netherlands 
      Clinical and Experimental Immunology, Maastricht University, Maastricht, the 
      Netherlands.
FAU - Korswagen, Lindy-Anne
AU  - Korswagen LA
AD  - Department of Rheumatology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20150826
PL  - England
TA  - BMJ Case Rep
JT  - BMJ case reports
JID - 101526291
RN  - 0 (Adjuvants, Immunologic)
RN  - 0 (Antibodies, Antineutrophil Cytoplasmic)
RN  - 2880D3468G (Levamisole)
RN  - EC 1.11.1.7 (Peroxidase)
RN  - I5Y540LHVR (Cocaine)
SB  - IM
MH  - Adjuvants, Immunologic/adverse effects/metabolism
MH  - Adult
MH  - Antibodies, Antineutrophil Cytoplasmic/*metabolism
MH  - *Cocaine/administration & dosage
MH  - *Cocaine-Related Disorders/complications
MH  - *Drug Contamination
MH  - Female
MH  - Glomerulonephritis/chemically induced
MH  - Hair/*metabolism
MH  - Humans
MH  - Levamisole/*adverse effects/metabolism
MH  - Peroxidase/metabolism
MH  - Recurrence
MH  - Vasculitis/*chemically induced
PMC - PMC4550939
EDAT- 2015/08/28 06:00
MHDA- 2016/05/10 06:00
PMCR- 2017/08/26
CRDT- 2015/08/28 06:00
PHST- 2015/08/28 06:00 [entrez]
PHST- 2015/08/28 06:00 [pubmed]
PHST- 2016/05/10 06:00 [medline]
PHST- 2017/08/26 00:00 [pmc-release]
AID - bcr-2015-210970 [pii]
AID - 10.1136/bcr-2015-210970 [doi]
PST - epublish
SO  - BMJ Case Rep. 2015 Aug 26;2015:bcr2015210970. doi: 10.1136/bcr-2015-210970.