Abstract: PUB454
Cocaine-Induced ANCA Negative Vasculitis: A Diagnostic Dilemma
Session Information
Category: Trainee Case Report
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Bhuta, Kunal, SUNY Upstate Medical University, Syracuse, New York, United States
- Devkota, Kriti, SUNY Upstate Medical University, Syracuse, New York, United States
- Mobeen, Haris, SUNY Upstate Medical University, Syracuse, New York, United States
- DiFilippo, William, SUNY Upstate Medical University, Syracuse, New York, United States
Introduction
Cocaine is an addictive stimulant drug. In 2014, 913,000 Americans met the criteria for dependence or abuse of cocaine. Almost 69% of Cocaine is contaminated with Levamisole which has been found to be immunogenic with anti-neutrophil cytoplasmic antibody (ANCA) associated cutaneous vasculitis in 88-100% patients.
Case Description
24-year old male with a history of substance abuse presented with bilateral lower limb weakness associated with burning pain and numbness in the right leg for 10 hours. He used cocaine one week prior to admission. Vitals were normal. See Table 1 for BMP. Labs also showed elevated SGOT of 1351 U/L, SGPT 460 U/L, elevated WBC. Urine analysis - pH 6.0, Hb 3+, RBC 14 and Protein 100. Renal ultrasound and Urine toxicology were negative. CPK levels (17,000 U/L) trended downwards. Urine microscopy showed muddy brown cast. Hepatitis serologies, Immunology including ANCA, C3, C4 were normal. Renal biopsy showed vasculitis, patchy interstitial edema along with focal collections of interstitial eosinophils. He was treated with hemodialysis and steroids.
Discussion
Cocaine can cause AKI by Rhabdomyolysis, Vasculitis, Platelet activation. Biopsy showed some focal vasculitis. Vasculitis in Cocaine abusers can be due to Levamisole, an anti-helminthic agent withdrawn due to multiple side effects. Levamisole is added to cocaine to enhance its euphoric effects. Levamisole induced ANCA positive vasculitis is well known. Our case is one of the few ANCA negative renal vasculitis responding to steroids.
Levamisole is detectable in urine for only 5-6 hours making diagnosis challenging. The role of steroids in the treatment of this condition has not been established. This patient responded well to steroids likely due to presence of interstitial inflammation. Research is required to understand effective ways to treatment this condition. Until then, primary treatment continues to be cessation of drug use and renal replacement therapy if needed.
Basic Metabolic Profile
| Sodium | 135 | 136-145 mmol/L |
| Potassium | 5.6 | 3.5-5.1 mmol/L |
| Bicarbonate | 23 | 22-29 mmol/L |
| BUN | 28 | 6-20 mg/dl |
| Creatinine | 2.85 | 0.5-1.2 mg/dl |
| Glucose | 115 | 70-140 mg/dl |
| Calcium | 8.1 | 8.6-10.0 mg/dl |