Abstract
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.
Key Indexing Terms
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REFERENCES
- Vasculitis mimics.Curr Opin Rheumatol. 2008; 20: 29-34
- Rheumatic manifestations of cocaine use.Curr Opin Rheumatol. 2012; 25: 50-55
- Cocaine-induced vasculitis: clinical and immunological spectrum.Curr Rheumatol Rep. 2012; 14: 532-538
- Cocaine-induced midline destruction lesions with positive ANCA test mimicking Wegener’s granulomatosis.Rev Bras Rheumatol. 2012; 52: 434-437
- Aggressive destructive midfacial lesion from cocaine abuse.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002; 94: 465-470
- Cocaine-induced midline destructive lesions mimicking ENT-limited Wegener’s granulomatosis.Scand J Rheumatol. 2008; 37: 477-480
- Antineutrophil cytoplasmic antibodies reacting with human neutrophil elastase as a diagnostic marker for cocaine-induced midline destructive lesions but not autoimmune vasculitis.Arthritis Rheum. 2004; 50: 2954-2965
- Syndrome of cocaine-levamisole-induced cutaneous vasculitis and immune-mediated leucopenia.Semin Arthritis Rheum. 2011; 41: 433-444
- Vasculopathy, hematological, and immune abnormalities associated with levamisole-contaminated cocaine use.Semin Arthritis Rheum. 2011; 41: 445-454
- Purpura, cutaneous necrosis, and anti-neutrophil cytoplasmic antibodies associated with levamisole-adulterated cocaine.Arthritis Rheum. 2011; 63: 3998-4001
Article info
Publication history
Accepted:
April 15,
2013
Received:
February 19,
2013
Footnotes
The authors have no financial or other conflicts of interest to disclose.
Identification
Copyright
© 2013 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
