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Case Reports in Medicine
Volume 2015, Article ID 547023, 3 pages
http://dx.doi.org/10.1155/2015/547023
Case Report

Systemic Levamisole-Induced Vasculitis in a Cocaine User without Cutaneous Findings: A Consideration in Diagnosis

1Department of Medicine, Emory University, Atlanta, GA 30308, USA
2Division of Renal Medicine, Department of Medicine, Emory University, Atlanta, GA 30308, USA
3Division of Hospital Medicine, Department of Medicine, Emory University, Atlanta, GA 30308, USA

Received 12 August 2015; Revised 22 September 2015; Accepted 27 September 2015

Academic Editor: Masahiro Kohzuki

Copyright © 2015 Gillian G. Baptiste et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.