Cocaine and ANCA associated vasculitis-like syndromes - A case series

Abstract

Objectives: We analysed the spectrum of clinical manifestations of cocaine associated pseudovasculitis.

Methods: Clinical, serological, radiological and histological features of 14 patients with cocaine pseudovasculitis syndromes were included.

Results: Twelve patients had significant sinus thickening or erosive disease. Other multi-system manifestations included vasculitic rashes, pulmonary lesions and peripheral neuropathy. All patients had positive ANCA titres at presentation. All patients were managed with corticosteroids +/- methotrexate and co-trimoxazole, 2 patients received cyclophosphamide.

Conclusions: Advanced erosive nasal septal defects and atypical ANCA patterns are suggestive of cocaine induced pseudovasculitis. Complete drug cessation may negate the need for exposure to potent immunosuppressive agents.

Keywords: ANCA associated vasculitis; Anti-neutrophil cytoplasmic antibody; Cocaine induced midline lesion; Drug-induced Vasculitis; Nasal disease; Vasculitis mimics.