Cocaine- and Levamisole-Induced Vasculitis: Defining the Spectrum of Autoimmune Manifestations

• Published in: Journal of clinical medicine Vol. 13; no. 17; p. 5116
• Main Authors: Iorio, Luca, Davanzo, Federica, Cazzador, Diego, Codirenzi, Marta, Fiorin, Eleonora, Zanatta, Elisabetta, Nicolai, Piero, Doria, Andrea, Padoan, Roberto
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 28.08.2024
• Subjects: Apoptosis; Cocaine; Drugs; Infections; Inflammation; Ischemia; Lupus; Nervous system; Neutrophils; Nose; Pathogenesis; Substance abuse treatment; CIV; LAC vasculopathy/vasculitis; ANCA; cocaine; levamisole; vasculitis; cocaine-induced midline destructive lesion; cocaine-induced vasculitis; antineutrophil cytoplasmic autoantibody; levamisole-adulterated cocaine; CIMDL
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm13175116

Drug-induced or associated vasculitis is a prevalent form of vasculitis that resembles primary idiopathic antineutrophil cytoplasmic autoantibody (ANCA) vasculitis (AAV). Cocaine is a diffuse psychostimulant drug and levamisole is a synthetic compound used to cut cocaine. Their abuse may result in a spectrum of autoimmune manifestations which could be categorized into three overlapping clinical pictures: cocaine-induced midline destructive lesion (CIMDL), levamisole-adulterated cocaine (LAC) vasculopathy/vasculitis, and cocaine-induced vasculitis (CIV). The mechanisms by which cocaine use leads to disorders resembling AAV are not well understood. Cocaine can cause autoimmune manifestations ranging from localized nasal lesions to systemic diseases, with neutrophils playing a key role through NETosis and ANCA development, which exacerbates immune responses and tissue damage. Diagnosing and treating these conditions becomes challenging when cocaine and levamisole abuse is not suspected, due to the differences and overlaps in clinical, diagnostic, therapeutic, and prognostic aspects compared to primary idiopathic vasculitides.