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Case Reports in Nephrology
Volume 2015 (2015), Article ID 372413, 5 pages
http://dx.doi.org/10.1155/2015/372413
Case Report

Levamisole/Cocaine Induced Systemic Vasculitis and Immune Complex Glomerulonephritis

1Department of Internal Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI 48073, USA
2Department of Nephrology, Washington University in St. Louis, St. Louis, MO 63130, USA
3Department of Nephrology, Oakland University William Beaumont School of Medicine, Royal Oak, MI 48073, USA
4Department of Pathology, William Beaumont Hospital, Royal Oak, MI 48073, USA

Received 2 April 2015; Accepted 14 July 2015

Academic Editor: Ze’ev Korzets

Copyright © 2015 Lohit Garg 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 an antihelminthic and immunomodulator medication that was banned by the USFDA in 1998. It has been increasingly used to adulterate cocaine due to its psychotropic effects and morphological properties. Adverse reactions including cutaneous vasculitis, thrombocytopenia, and agranulocytosis have been well described. Despite systemic vasculitis in this setting, renal involvement is uncommon. We report here a case of ANCA positive systemic vasculitis with biopsy proven immune complex mediated glomerulonephritis likely secondary to levamisole/cocaine. A 40-year-old Caucasian male with no past medical history presented with 3-week history of fatigue, skin rash, joint pains, painful oral lesions, oliguria, hematuria, worsening dyspnea on exertion, and progressive lower extremity edema. He had a history of regular tobacco and cocaine use. Lab testing revealed severe anemia, marked azotemia, deranged electrolytes, and 4.7 gm proteinuria. Rheumatologic testing revealed hypocomplementemia, borderline ANA, myeloperoxidase antibody, and positive atypical p-ANCA. Infectious and other autoimmune workup was negative. Kidney biopsy was consistent with immune mediated glomerulonephritis and showed mesangial proliferation and immune complex deposition consisting of IgG, IgM, and complement. High dose corticosteroids and discontinuing cocaine use resulted in marked improvement in rash, mucocutaneous lesions, and arthritis. There was no renal recovery and he remained hemodialysis dependent.