Abstract: SA-PO265
A Curious Case of Methamphetamine Induced Renal Pseudo-Vasculitis
Session Information
- Trainee Case Reports - VI
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Chamarthi, Gajapathiraju, University of Flroida, Gainesville, Florida, United States
- Lee Loy, Justin, University of Flroida, Gainesville, Florida, United States
- Koratala, Abhilash, University of Flroida, Gainesville, Florida, United States
Introduction
Methamphetamine is a synthetic-drug that is widely abused by young adults and can have deleterious effects on many organ systems including the kidney. Hyponatremia and AKI from non-traumatic rhabdomyolysis are the most common manifestations pertinent to renal system. Herein, we present a case of methamphetamine ingestion mimicking systemic vasculitis in a patient with multiorgan failure.
Case Description
A 38-year-old man who was otherwise healthy except for chronic back pain presented to the local hospital with weakness and epigastric pain. Examination revealed several skin pustules on his legs, which he attributed to insect bites. His urine toxicology screen was positive for amphetamines and serum creatinine (Scr) was 1.4mg/dL. He soon developed sepsis with respiratory failure requiring mechanical ventilation and AKI requiring dialysis and transferred to our facility for further management. On exam, petechial and purpuric lesions were noted on legs and laboratory data including serum CPK, liver enzymes, IgG4 were within normal limits. Viral Hepatitis and HIV testing, vasculitic work up including ANA, ANCA, cryoglobulin was negative. Skin biopsy was not suggestive of vasculitis but could not yield specific etiology. Renal biopsy was consistent with ATN but also showed medium vessel vasculitis (Figure) which can be associated with illicit drug use such as cocaine and methamphetamine. Patient had renal recovery and was dialysis independent at discharge.
Discussion
Amphetamine derivatives are widely abused drugs for their euphoric, stimulant and hallucinogen properties. Hyponatremia and AKI are frequent complications of their use. AKI typically results from rhabdomyolysis. Other rare manifestations such as isolated proximal tubular dysfunction, obstructive nephropathy from bladder neck dysfunction and seronegative necrotizing vasculitis as in our patient have been reported and Nephrologists have to be familiar with these for appropriate management.