Pauci-immune glomerulonephritis in individuals with disease associated with levamisole-adulterated cocaine a series of 4 cases

Adam Q. Carlson, Delphine S. Tuot, Kuang-Yu Jen, Brad Butcher, Jonathan Graf, Ramin Sam, John B. Imboden

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Exposure to levamisole-adulterated cocaine can induce a distinct clinical syndrome characterized by retiform purpura and/or agranulocytosis accompanied by an unusual constellation of serologic abnormalities including antiphospholipid antibodies, lupus anticoagulants, and very high titers of antineutrophil cytoplasmic antibodies. Two recent case reports suggest that levamisoleadulterated cocaine may also lead to renal disease in the form of pauci-immune glomerulonephritis. To explore this possibility, we reviewed cases of pauci-immune glomerulonephritis between 2010 and 2012 at an inner city safety net hospital where the prevalence of levamisole in the cocaine supply is known to be high. We identified 3 female patients and 1 male patient who had biopsyproven pauci-immune glomerulonephritis, used cocaine, and had serologic abnormalities characteristic of levamisole-induced autoimmunity. Each also had some other form of clinical disease known to be associated with levamisole, either neutropenia or cutaneous manifestations. One patient had diffuse alveolar hemorrhage. Three of the 4 patients were treated with short courses of prednisone and cyclophosphamide, 2 of whom experienced stable long-term improvement in their renal function despite ongoing cocaine use. The remaining 2 patients developed end-stage renal disease and became dialysis-dependent. This report supports emerging concern of more wide spread organ toxicity associated with the use of levamisole-adulterated cocaine.

Original languageEnglish (US)
Pages (from-to)290-297
Number of pages8
JournalMedicine (United States)
Volume93
Issue number17
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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Levamisole
Glomerulonephritis
Cocaine
Safety-net Providers
Kidney
Skin Manifestations
Lupus Coagulation Inhibitor
Antineutrophil Cytoplasmic Antibodies
Agranulocytosis
Antiphospholipid Antibodies
Purpura
Prednisone
Neutropenia
Autoimmunity
Cyclophosphamide
Chronic Kidney Failure
Dialysis
Hemorrhage

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Pauci-immune glomerulonephritis in individuals with disease associated with levamisole-adulterated cocaine a series of 4 cases. / Carlson, Adam Q.; Tuot, Delphine S.; Jen, Kuang-Yu; Butcher, Brad; Graf, Jonathan; Sam, Ramin; Imboden, John B.

In: Medicine (United States), Vol. 93, No. 17, 01.01.2014, p. 290-297.

Research output: Contribution to journalArticle

Carlson, Adam Q. ; Tuot, Delphine S. ; Jen, Kuang-Yu ; Butcher, Brad ; Graf, Jonathan ; Sam, Ramin ; Imboden, John B. / Pauci-immune glomerulonephritis in individuals with disease associated with levamisole-adulterated cocaine a series of 4 cases. In: Medicine (United States). 2014 ; Vol. 93, No. 17. pp. 290-297.
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