It has been recognized that nasal cocaine abuse can induce midline destructive lesions that can mimic different disorders, including small-vessel vasculitis. The authors reported 2 cases of patients referred to the rheumatology clinic with a previous diagnosis of granulomatosis with polyangiitis (Wegener's granulomatosis), presenting with chronic perforation in the palate, refractory to immunosuppressant therapy. In both patients, laboratory investigation revealed antineutrophil cytoplasmic antibody positivity. A differential diagnosis between cocaine-induced midline destructive lesions and granulomatosis with polyangiitis is also difficult to establish because of the presence of antineutrophil cytoplasmic antibody in both disorders. Given the high prevalence of cocaine use, awareness of this mimic is essential to avoid a misdiagnosis and the use of unnecessary and potential toxic therapies.
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Accepted: April 15, 2013
Received: February 19, 2013
The authors have no financial or other conflicts of interest to disclose.
© 2013 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.