Cocaine-induced Vasculitis

Abstract

A bbreviations: A NCA, a nti-neutrophil cy toplasm ic a ntibody; CIMDL, cocaine-induced m idline destructive lesion; GPA, g r anulom atosis with poly angiitis; HNE, human neutrophil elastase; MPO, myeloperoxidase; PR3, proteinase 3 . Ci t ation: Berman M, Paran D, Elkayam O . Cocaine-Induced Vasculitis. Rambam Ma im onides Med J 2016;7 (4):e0036. doi:1 0.5041/RMMJ.1 0263 Review Copy r ight: © 2 016 Berman et al. T his is an open-access article. A ll its content, except w here otherwise noted, is dist ributed under the terms of t he Creative Com mons Attribution License (http://creativecom mons.org/licenses/by/3.0), w h ich permits unrestricted u se, distribution, a nd reproduction in any m edium, prov ided the original work is properly cit ed. Ram bam Maim onides Med J | www.rmmj.org.il 1 October 2016  Volum e 7  Issue 4  e0036 ABST RACT The use of cocaine continues to grow worldwide. One of the possible side-effects of cocaine is vasculitis. Two distinct vasculitic syndromes have been described due to cocaine. One is cocaine -induced midline destruc-tiv e lesion, secondary to a direct vasoconstrictor effect of cocaine, inducing ischemic necrosis of the septal cartilage and perforation of the nasal septum, mimicking findings of granulomatosis with polyangiitis in the upper airways. The other is ANCA -associated v asculitis, attributed to the lev amisole component that contaminates about 7 0% of the cocaine. This ty pe of v asculitis may be my eloperox idase (MPO) and proteinase 3 (PR3) positiv e, and its main manifestations are typical cutaneous findings, arthralgia, oto-lary ngologic involvement, and agranulocytosis. A high degree of suspicion and awareness is needed in order properly to diagnose and treat these patients.