Vasculitis due to cocaine adulterated with levamisole with digital ischemia and humeral thrombosis
DOI:
https://doi.org/10.32818/reccmi.a10n3a9Keywords:
ANCA vasculitis, antineutrophil cytoplasmic autoantibodies, human neutrophil elastase antibody (HNE-ANCA), cocaine, levamisoleAbstract
Levamisole-induced anti-neutrophil cytoplasmic antibodies (ANCA) vasculitis is a complication associated with the use of adulterated cocaine with anthelmintic drugs. This condition is characterized by necrotizing skin lesions, mild systemic symptoms, and the detection of atypical ANCA antibodies. Its incidence is particularly high in the United States, where 70% of cocaine is contaminated with levamisole. The case involves a 45-year-old male with a history of hypertension and smoking who was admitted for digital ischemia of the right hand. He was a cocaine user and had facial deformity and a “saddle nose”. The findings of upper limb arteriography and the presence of ANCA against human neutrophil elastase (HNE-ANCA) led to the diagnosis of cocaine (and levamisole)-induced vasculitis. A differential diagnosis was made with Buerger's disease. Cessation of drug use was key to the favorable evolution of digital arterial ischemia.
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Copyright (c) 2025 Ángela García-de Oro, Carolina Fernández-Catalán, Cristina Lozano-Ruiz, José Luis Rodríguez-García
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