Many of these drugs, including but not limited to amphetamines (including prescription and over-the-counter medications containing amphetamine-like substances) and cocaine, have also been linked to unusual rheumatic syndromes and vasculitis. Illicit drug use is common in many societies across the globe and causes significant morbidity and mortality relating to well known harmful physiologic effects of these substances. Given the high prevalence of cocaine use and its adulteration with levamisole, clinicians should be familiar with these rheumatic manifestations in order to avoid misdiagnosis and unnecessary treatment with potentially toxic therapies. SummaryĬocaine use is associated with clinical syndromes that closely mimic other primary rheumatic diseases. With the recent introduction of levamisole as a cocaine adulterant, a newly reported syndrome has emerged that is associated with neutropenia, retiform purpura with cutaneous necrosis and autoantibodies consisting of high-titre perinuclear antineutrophil cytoplasmic antibodies (p-ANCAs) with specificities for ‘atypical’ antigens. Many of these illnesses are associated with antineutrophil cytoplasmic antibodies (cytoplasmic, perinuclear and atypical perinuclear patterns). These disorders can range in severity from purely cosmetic damage to organ and/or life-threatening disease that includes sinonasal destruction and vasculitis. Recent findingsĬocaine use has been linked to several distinctive syndromes that can be difficult to distinguish from idiopathic rheumatic diseases. This review summarizes these clinical manifestations and highlights recent developments linked to levamisole-adulterated cocaine. Cocaine use is associated with several rheumatic syndromes.
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February 2023
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