PT  - JOURNAL ARTICLE
AU  - Tjeerd van der Veer
AU  - Ed Pennings
AU  - J W Cohen Tervaert
AU  - Lindy-Anne Korswagen
TI  - Levamisole-contaminated cocaine: a hairy affair
AID  - 10.1136/bcr-2015-210970
DP  - 2015 Aug 26
TA  - BMJ Case Reports
PG  - bcr2015210970
VI  - 2015
4099  - http://casereports.bmj.com/content/2015/bcr-2015-210970.short
4100  - http://casereports.bmj.com/content/2015/bcr-2015-210970.full
AB  - Levamisole-contaminated cocaine can induce severe systemic vasculitis. The diagnosis can be challenging, especially when substance abuse is uncertain. We present the case of a 42-year-old woman suffering from vasculitis due to levamisole-contaminated cocaine, who persistently denied substance abuse. Symptoms included ulcerating skin lesions, arthralgia and myalgia, and the occurrence of an ileal intussusception. The definitive diagnosis was made using hair testing for toxins. She recovered through cocaine abstinence, but re-exposure resulted in a severe relapse with glomerulonephritis. Importantly, at time of the relapse, the patient became positive for both myeloperoxidase-antineutrophil cytoplasmic antibody (ANCA) and proteinase 3-ANCA. Cocaine–levamisole-induced vasculitis poses a great clinical challenge. The proper diagnostic strategy and therapy is still controversial. We highlight our diagnostic and therapeutic considerations, including hair testing for definitive proof of exposure.