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Pendolino AL, Benshetrit G, Navaratnam AV, To C, Bandino F, Scarpa B, Kwame I, Ludwig DR, McAdoo S, Kuchai R, Gane S, Saleh H, Pusey CD, Randhawa PS, Andrews PJ. The role of ANCA in the management of cocaine-induced midline destructive lesions or ENT pseudo-granulomatosis with polyangiitis: a London multicentre case series. Laryngoscope 2024; 134:2609-2616. [PMID: 38084793 DOI: 10.1002/lary.31219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/07/2023] [Accepted: 11/21/2023] [Indexed: 05/09/2024]
Abstract
OBJECTIVE In this multicentric study involving three London hospitals, we compared ANCA-positive and ANCA-negative cocaine-induced midline destructive lesions (CIMDL) patients to assess how presence of antineutrophil cytoplasmic antibodies (ANCA) may correlate with disease severity. Our secondary aims are to better classify etiology centered around ANCA positivity and, consequently, better disease management. METHODS A retrospective review was performed to identify patients with CIMDL seen between January 2019 and December 2022. Population data including age, sex, presentation, endoscopic findings, duration of cocaine use and active use of cocaine, type of treatment, laboratory (including ANCA serology), radiological, and histological findings were collected. RESULTS Forty CIMDL patients (25 male, median age of 42 years) were identified. The majority of them (72.5%) presented with either a septal perforation, a saddle nose deformity (22.5%), and/or a palatal fistula (20.0%). ANCA was positive in 71.1% of cases (66.7% p-ANCA). No statistically significant differences in the general characteristics, type of treatment, laboratory results, radiological or histological findings were observed when comparing ANCA-positive and ANCA-negative CIMDL patients or when comparing p-ANCA and c-ANCA patients. Similarly, no statistically significant difference was obtained when comparing the pattern of distribution of lesions between the two groups. CONCLUSIONS A large percentage of CIMDL patients showed positive ANCA test (71.1%) and in the majority of the cases a p-ANCA pattern specifically targeting PR3 (p-ANCA, PR3 + MPO-). However, ANCA positivity or presence of a specific ANCA pattern was not associated with more severe presentation or more aggressive disease. Given its similarities to granulomatosis with polyangiitis (GPA), we recommend the use of the term "cocaine-induced ENT pseudo-GPA" instead of CIMDL. LEVEL OF EVIDENCE IV Laryngoscope, 134:2609-2616, 2024.
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Affiliation(s)
- Alfonso Luca Pendolino
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London, UK
- Ear Institute, UCL, London, UK
| | - Guy Benshetrit
- Department of ENT, Imperial College Hospitals, London, UK
| | | | - Caroline To
- Department of Allergy, Royal Brompton Hospital, London, UK
- Department of Immunology and Allergy, Princess Alexandra Hospital, Brisbane, Australia
| | - Fabrizio Bandino
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London, UK
| | - Bruno Scarpa
- Department of Statistical Sciences and Department of Mathematics Tullio Levi-Civita, University of Padova, Padova, Italy
| | - Ivor Kwame
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London, UK
| | - Dalia R Ludwig
- Rheumatology Department, University College London Hospitals, London, UK
| | - Stephen McAdoo
- Department of ENT, Imperial College Hospitals, London, UK
| | - Romana Kuchai
- Department of ENT, Imperial College Hospitals, London, UK
| | - Simon Gane
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London, UK
| | - Hesham Saleh
- Department of ENT, Imperial College Hospitals, London, UK
| | - Charles D Pusey
- Department of ENT, Imperial College Hospitals, London, UK
- Renal Department, Imperial College Hospitals, London, UK
| | - Premjit S Randhawa
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London, UK
| | - Peter J Andrews
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London, UK
- Ear Institute, UCL, London, UK
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Renuncio-García M, Calvo-Río V, Benavides-Villanueva F, Al Fazazi S, Rodríguez-Vidriales M, Escagedo-Cagigas C, Martín-Penagos L, Irure-Ventura J, López-Hoyos M, Blanco R. ANCA detection with solid phase chemiluminescence assay: diagnostic and severity association in vasculitis. Immunol Res 2024; 72:128-133. [PMID: 37676628 PMCID: PMC10810966 DOI: 10.1007/s12026-023-09422-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/31/2023] [Indexed: 09/08/2023]
Abstract
ANCA-associated vasculitis (AAV) comprises a group of necrotizing vasculitis that mainly affects small- and medium-sized vessels. Serum anti-neutrophil cytoplasmic antibodies (ANCA), mainly anti-myeloperoxidase (anti-MPO) and anti-proteinase 3 (anti-PR3), levels may correlate to severity, prognosis, and recurrence of the disease. A retrospective analysis of 101 patients with MPO-positive and 54 PR3-positive vasculitis was performed, using laboratory established cut-off value, measured by chemiluminescence. Furthermore, data of renal disease and pulmonary involvement were collected at vasculitis diagnosis, as well as the progress, requiring dialysis, transplant, or mortality. For anti-MPO antibodies with a diagnosis of vasculitis (n = 77), an area under the curve (AUC) was calculated (AUC = 0.8084), and a cut-off point of 41.5 IU/ml was determined. There were significant differences in anti-MPO levels between patients with renal or pulmonary dysfunction (n = 65) versus those without them (n = 36) (p = 0.0003), and a cut-off threshold of 60 IU/ml was established. For anti-PR3 antibodies with a diagnosis of vasculitis (n = 44), an area under the curve (AUC) was calculated (AUC = 0.7318), and a cut-off point of 20.5 IU/ml was determined. Significant differences in anti-PR3 levels were observed between those patients with renal or pulmonary dysfunction (n = 30) and those without them (n = 24) (p = 0.0048), and a cut-off threshold of 41.5 IU/ml was established. No significant differences between those patients who had a worse disease progression and those who did not were found for anti-MPO and anti-PR3. Anti-MPO and anti-PR3 levels at the moment of vasculitis diagnosis are related with disease severity but not with disease outcome or vasculitis recurrence.
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Affiliation(s)
- Mónica Renuncio-García
- Department of Immunology, Marqués de Valdecilla University Hospital, Avda. Valdecilla S/N, 39008, Santander, Cantabria, Spain
- Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, 39011, Santander, Spain
| | - Vanesa Calvo-Río
- Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, 39011, Santander, Spain
- Department of Rheumatology, Marqués de Valdecilla University Hospital, 39008, Santander, Cantabria, Spain
| | | | - Salma Al Fazazi
- Department of Rheumatology, Puerta del Mar University Hospital, 11009, Cádiz, Andalucía, Spain
| | - María Rodríguez-Vidriales
- Department of Nephrology, Marqués de Valdecilla University Hospital, 39008, Santander, Cantabria, Spain
| | - Clara Escagedo-Cagigas
- Department of Nephrology, Marqués de Valdecilla University Hospital, 39008, Santander, Cantabria, Spain
| | - Luis Martín-Penagos
- Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, 39011, Santander, Spain
- Department of Nephrology, Marqués de Valdecilla University Hospital, 39008, Santander, Cantabria, Spain
| | - Juan Irure-Ventura
- Department of Immunology, Marqués de Valdecilla University Hospital, Avda. Valdecilla S/N, 39008, Santander, Cantabria, Spain
- Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, 39011, Santander, Spain
| | - Marcos López-Hoyos
- Department of Immunology, Marqués de Valdecilla University Hospital, Avda. Valdecilla S/N, 39008, Santander, Cantabria, Spain.
- Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, 39011, Santander, Spain.
- Molecular Biology Dpt., Universidad Cantabria, Santander, Spain.
| | - Ricardo Blanco
- Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, 39011, Santander, Spain
- Department of Rheumatology, Marqués de Valdecilla University Hospital, 39008, Santander, Cantabria, Spain
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3
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Ruffer N, Krusche M, Holl-Ulrich K, Kötter I, Lötscher F. [Cocaine-induced vasculitis and mimics of vasculitis]. Z Rheumatol 2023; 82:606-614. [PMID: 35612660 PMCID: PMC10495486 DOI: 10.1007/s00393-022-01217-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2022] [Indexed: 11/29/2022]
Abstract
Cocaine is a psychotropic tropane alkaloid and stimulant drug. Nasal insufflation of cocaine powder is a common route of administration. In Germany, cocaine is frequently adulterated with levamisole, an anthelminthic drug with immunomodulatory effects. Both substances are linked to various autoimmune conditions. Cocaine-induced midline destructive lesions cause a progressive destruction of osteocartilaginous structures within the upper respiratory tract and can mimic localized granulomatosis with polyangiitis. In addition, systemic vasculitis due to cocaine and levamisole has been reported. Differentiation of these conditions from primary vasculitis can be challenging because antineutrophil cytoplasmic antibodies (ANCA) are commonly detected. Early diagnosis of these conditions is crucial as clinical improvement is closely related to drug cessation.
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Affiliation(s)
- Nikolas Ruffer
- Klinik für Rheumatologie und Immunologie, Klinikum Bad Bramstedt, Bad Bramstedt, Deutschland.
- Sektion Rheumatologie und entzündliche Systemerkrankungen, III. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
| | - Martin Krusche
- Sektion Rheumatologie und entzündliche Systemerkrankungen, III. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Konstanze Holl-Ulrich
- Konsultations- und Referenzzentrum für Vaskulitis-Diagnostik, Pathologie-Hamburg, Labor Lademannbogen MVZ GmbH, Hamburg, Deutschland
| | - Ina Kötter
- Klinik für Rheumatologie und Immunologie, Klinikum Bad Bramstedt, Bad Bramstedt, Deutschland
- Sektion Rheumatologie und entzündliche Systemerkrankungen, III. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Fabian Lötscher
- Universitätsklinik für Rheumatologie, Immunologie und Allergologie, Inselspital, Universitätsspital Bern, Bern, Schweiz
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Keim CK, Schwartz RA, Kapila R. Levamisole-induced and COVID-19-induced retiform purpura: two overlapping, emerging clinical syndromes. Arch Dermatol Res 2023; 315:265-273. [PMID: 34807290 PMCID: PMC8607060 DOI: 10.1007/s00403-021-02303-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 11/11/2021] [Indexed: 10/28/2022]
Abstract
Levamisole exposure in cocaine users is a well-recognized cause of retiform purpura, a distinctive net-like maculopapular patch. Prolonged exposure to levamisole can lead to a serious systemic syndrome known as levamisole-induced vasculitis, most commonly involving the kidneys and lungs. More recently, retiform purpura has been observed in patients with the novel coronavirus disease of 2019 (COVID-19). Due to their overlapping dermatologic and systemic manifestations, levamisole-induced and COVID-19-induced retiform purpura may mimic one another in clinical presentation. The possibility that patients may present with one or both syndromes creates a diagnostic challenge. This review of levamisole-induced and COVID-19-induced retiform purpura highlights their corresponding and distinctive features. Additionally, we propose a unique staging system for levamisole-induced retiform purpura that may be valid for future classification of COVID-19-induced retiform purpura.
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Affiliation(s)
- Catherine K. Keim
- grid.430387.b0000 0004 1936 8796Rutgers New Jersey Medical School, MSB H-576, 185 South Orange Ave, Newark, NJ 07103 USA
| | - Robert A. Schwartz
- grid.430387.b0000 0004 1936 8796Dermatology and Pathology, Rutgers New Jersey Medical School, MSB H-576, 185 South Orange Ave, Newark, NJ 07103 USA
| | - Rajendra Kapila
- grid.430387.b0000 0004 1936 8796Infectious Diseases, Rutgers New Jersey Medical School, MSB H-576, 185 South Orange Ave, Newark, NJ 07103 USA
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5
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B7-1 mediates podocyte injury and glomerulosclerosis through communication with Hsp90ab1-LRP5-β-catenin pathway. Cell Death Differ 2022; 29:2399-2416. [PMID: 35710882 PMCID: PMC9750974 DOI: 10.1038/s41418-022-01026-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 06/01/2022] [Accepted: 06/03/2022] [Indexed: 02/08/2023] Open
Abstract
Podocyte injury is a hallmark of glomerular diseases; however, the underlying mechanisms remain unclear. B7-1 is increased in injured podocytes, but its intrinsic role is controversial. The clinical data here revealed the intimate correlation of urinary B7-1 with severity of glomerular injury. Through transcriptomic and biological assays in B7-1 transgenic and adriamycin nephropathy models, we identified B7-1 is a key mediator in podocyte injury and glomerulosclerosis through a series of signal transmission to β-catenin. Using LC-MS/MS, Hsp90ab1, a conserved molecular chaperone, was distinguished to be an anchor for transmitting signals from B7-1 to β-catenin. Molecular docking and subsequent mutant analysis further identified the residue K69 in the N terminal domain of Hsp90ab1 was the key binding site for B7-1 to activate LRP5/β-catenin pathway. The interaction and biological functions of B7-1-Hsp90ab1-LRP5 complex were further demonstrated in vitro and in vivo. We also found B7-1 is a novel downstream target of β-catenin. Our results indicate an intercrossed network of B7-1, which collectively induces podocyte injury and glomerulosclerosis. Our study provides an important clue to improve the therapeutic strategies to target B7-1.
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Abstract
PURPOSE OF REVIEW Drug-induced vasculitis (DIV) is a rare form of vasculitis related to the use of various drugs. DIV primarily affects small to medium size vessels, but it can potentially involve vessels of any size. Differentiating between primary systemic vasculitis and DIV can be challenging; however, it is crucial, so that the offending agent can be discontinued promptly. RECENT FINDINGS The clinical phenotype of DIV is protean and depends on the size of the affected vessels. It ranges from arthralgias, to an isolated cutaneous rash, to severe single or multi-organ involvement. While withdrawal of the offending drug is the most important step in management, a significant number of patients require immunosuppressive therapy for varying periods of time. DIV can affect any vascular bed size, leading to protean vasculitic syndromes. Increased awareness among general practitioners, specialty, and subspecialty physicians is crucial for early recognition, and withdrawal of drug for better outcomes.
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7
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Asemota U, Greenberg S, Gulati A, Kumar K, Janga K. Tofacitinib-Induced Antineutrophil Cytoplasmic Antibodies (ANCA)-Associated Vasculitis With Crescentic Glomerulonephritis. Cureus 2021; 13:e18663. [PMID: 34790443 PMCID: PMC8583358 DOI: 10.7759/cureus.18663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2021] [Indexed: 12/30/2022] Open
Abstract
Antineutrophil cytoplasmic antibodies (ANCA) vasculitis is common after the age of 50 years but it can occur at any age. There is a slight male preponderance and it is more common in Whites than Blacks but the black race confers a worse prognosis. The clinical features of ANCA vasculitis vary considerably. The manifestation of the disease depends on the organs affected, the chronicity of the disease, and how quiescent it is. Non-specific symptoms of malaise, fatigue, fever, and weight loss are common. Crescentic glomerulonephritis with focal necrosis is usually the pathology underlying renal disease. Manifestations of renal disease include hematuria and proteinuria which may progress to renal failure. We present a case of a 75-year-old female who presented with acute worsening of renal function and nephrotic-range proteinuria with positive testing for p-ANCA after the recent commencement of treatment with tofacitinib. This prompted a suspicion of ANCA-vasculitis. The patient was started on pulse dose steroids and rituximab after kidney biopsy confirmation of ANCA-vasculitis with crescentic glomerulonephritis.
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Affiliation(s)
| | | | - Amit Gulati
- Internal Medicine, Maimonides Medical Center, Brooklyn, USA
| | - Kamlesh Kumar
- Internal Medicine, Maimonides Medical Center, Brooklyn, USA
| | - Kalyana Janga
- Nephrology, Maimonides Medical Center, Brooklyn, USA
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8
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Laurentino AOM, Solómon J, Tonietto BD, Cestonaro LV, Dos Santos NG, Piton YV, Izolan L, Marques D, Costa-Valle MT, Garcia SC, Sebben V, Dallegrave E, Schaefer PG, Barros EJ, Arbo MD, Leal MB. Levamisole, a cocaine cutting agent, induces acute and subchronic systemic alterations in Wistar rats. Toxicol Appl Pharmacol 2021; 426:115649. [PMID: 34273407 DOI: 10.1016/j.taap.2021.115649] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/14/2021] [Accepted: 07/09/2021] [Indexed: 12/31/2022]
Abstract
The use of the anthelmintic levamisole as a cocaine adulterant has been increasing worldwide. Complications caused by this association include systemic vasculitis, agranulocytosis, neutropenia, tissue necrosis, pulmonary hemorrhage, and renal injury. Data about toxicity of levamisole are scarce, therefore the aim of this study was to evaluate the acute and subchronic toxic effects of levamisole in rats. Male Wistar rats received saline or levamisole by intraperitoneal route at the doses of 12, 24 and 36 mg/kg in the acute toxicity test; and at 3, 6 and 12 mg/kg in the subchronic toxicity test. Toxicity was evaluated using behavioral, cognitive, renal, hematological, biochemical and histopathological parameters. Acute administration of levamisole caused behavioral and histopathological alterations. Subchronic administration caused behavioral, cognitive and hematological alterations (p < 0.0001 and p < 0.05, respectively), impairment of liver and kidney functions (p < 0.05), and changes of antioxidant defenses (p ≤ 0.0001). Both administrations produced toxic effects of clinical relevance, which make levamisole a dangerous cutting agent. Furthermore, the knowledge of these effects can contribute to the correct diagnosis and treatment of cocaine dependents with unusual systemic alterations.
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Affiliation(s)
- Ana Olívia Martins Laurentino
- Programa de Pós-Graduação em Ciências Biológicas, Farmacologia e Terapêutica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Sarmento Leite, 500/305, 90050-170 Porto Alegre, Rio Grande do Sul, Brazil; Laboratório de Farmacologia e Toxicologia Neurocomportamental, Departamento de Farmacologia, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Sarmento Leite, 500/305, 90050-170 Porto Alegre, Rio Grande do Sul, Brazil
| | - Janaína Solómon
- Laboratório de Farmacologia e Toxicologia Neurocomportamental, Departamento de Farmacologia, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Sarmento Leite, 500/305, 90050-170 Porto Alegre, Rio Grande do Sul, Brazil
| | - Bruna Ducatti Tonietto
- Laboratório de Toxicologia (LATOX), Departamento de Análises, Faculdade de Farmácia - Anexo I, Universidade Federal do Rio Grande do Sul (UFRGS), Rua São Luis, 150/3° andar, 90620-170 Porto Alegre, Rio Grande do Sul, Brazil; Programa de Pós-Graduação em Ciências Farmacêuticas (PPGCF), Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Ipiranga 2752/1° andar, 90610-000 Porto Alegre, Rio Grande do Sul, Brazil
| | - Larissa Vivan Cestonaro
- Laboratório de Toxicologia (LATOX), Departamento de Análises, Faculdade de Farmácia - Anexo I, Universidade Federal do Rio Grande do Sul (UFRGS), Rua São Luis, 150/3° andar, 90620-170 Porto Alegre, Rio Grande do Sul, Brazil; Programa de Pós-Graduação em Ciências Farmacêuticas (PPGCF), Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Ipiranga 2752/1° andar, 90610-000 Porto Alegre, Rio Grande do Sul, Brazil
| | - Nícolas Guimarães Dos Santos
- Laboratório de Toxicologia (LATOX), Departamento de Análises, Faculdade de Farmácia - Anexo I, Universidade Federal do Rio Grande do Sul (UFRGS), Rua São Luis, 150/3° andar, 90620-170 Porto Alegre, Rio Grande do Sul, Brazil
| | - Yasmin Vendruscolo Piton
- Laboratório de Toxicologia (LATOX), Departamento de Análises, Faculdade de Farmácia - Anexo I, Universidade Federal do Rio Grande do Sul (UFRGS), Rua São Luis, 150/3° andar, 90620-170 Porto Alegre, Rio Grande do Sul, Brazil
| | - Lucas Izolan
- Programa de Pós-Graduação em Ciências Biológicas: Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Sarmento Leite, 500/209, 90046-900 Porto Alegre, Rio Grande do Sul, Brazil
| | - Douglas Marques
- Laboratório de Farmacologia e Toxicologia Neurocomportamental, Departamento de Farmacologia, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Sarmento Leite, 500/305, 90050-170 Porto Alegre, Rio Grande do Sul, Brazil; Programa de Pós-Graduação em Ciências Biológicas: Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Sarmento Leite, 500/209, 90046-900 Porto Alegre, Rio Grande do Sul, Brazil
| | - Marina Tuerlinckx Costa-Valle
- Departamento de Farmacociências, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Rua Sarmento Leite, 245, 90050-170 Porto Alegre, Rio Grande do Sul, Brazil
| | - Solange Cristina Garcia
- Laboratório de Toxicologia (LATOX), Departamento de Análises, Faculdade de Farmácia - Anexo I, Universidade Federal do Rio Grande do Sul (UFRGS), Rua São Luis, 150/3° andar, 90620-170 Porto Alegre, Rio Grande do Sul, Brazil; Programa de Pós-Graduação em Ciências Farmacêuticas (PPGCF), Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Ipiranga 2752/1° andar, 90610-000 Porto Alegre, Rio Grande do Sul, Brazil
| | - Viviane Sebben
- Centro de Informação Toxicológica, Av. Ipiranga, 5400, 90610-000 Porto Alegre, Rio Grande do Sul, Brazil
| | - Eliane Dallegrave
- Departamento de Farmacociências, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Rua Sarmento Leite, 245, 90050-170 Porto Alegre, Rio Grande do Sul, Brazil
| | - Pedro Guilherme Schaefer
- Faculdade de Medicina, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), R. Ramiro Barcelos, 2350, 90035-007 Porto Alegre, Rio Grande do Sul, Brazil
| | - Elvino José Barros
- Faculdade de Medicina, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), R. Ramiro Barcelos, 2350, 90035-007 Porto Alegre, Rio Grande do Sul, Brazil
| | - Marcelo Dutra Arbo
- Laboratório de Toxicologia (LATOX), Departamento de Análises, Faculdade de Farmácia - Anexo I, Universidade Federal do Rio Grande do Sul (UFRGS), Rua São Luis, 150/3° andar, 90620-170 Porto Alegre, Rio Grande do Sul, Brazil; Programa de Pós-Graduação em Ciências Farmacêuticas (PPGCF), Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Ipiranga 2752/1° andar, 90610-000 Porto Alegre, Rio Grande do Sul, Brazil.
| | - Mirna Bainy Leal
- Programa de Pós-Graduação em Ciências Biológicas, Farmacologia e Terapêutica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Sarmento Leite, 500/305, 90050-170 Porto Alegre, Rio Grande do Sul, Brazil; Laboratório de Farmacologia e Toxicologia Neurocomportamental, Departamento de Farmacologia, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Sarmento Leite, 500/305, 90050-170 Porto Alegre, Rio Grande do Sul, Brazil; Programa de Pós-Graduação em Ciências Biológicas: Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Sarmento Leite, 500/209, 90046-900 Porto Alegre, Rio Grande do Sul, Brazil.
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9
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Affiliation(s)
- Cristina López-Sánchez
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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Krischock L, Pannila P, Kennedy SE. Levamisole and ANCA positivity in childhood nephrotic syndrome. Pediatr Nephrol 2021; 36:1795-1802. [PMID: 33484340 DOI: 10.1007/s00467-020-04915-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/03/2020] [Accepted: 12/31/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study aimed to determine the prevalence of ANCA positivity in children managed with levamisole as a steroid-sparing agent for nephrotic syndrome (NS). METHODS Medical records of children with steroid-sensitive NS managed with levamisole therapy at Sydney Children's Hospital between 1/1/2000 and 31/12/2018 were retrospectively reviewed. Main outcome measure was side effects of levamisole therapy including ANCA positivity. RESULTS Seventy-one children, median age 3 years and 1 month (IQR 29-68 months) at first presentation, were subsequently managed with levamisole. 60.6% were male and 65% Caucasian. 47.9% had frequently relapsing (FR)NS and 52.1% steroid-dependent (SD)NS. Overall, there was a median reduction in relapses from 3 (IQR 1-5) to 0.4 relapses (IQR 0-1) per year after levamisole was commenced. Levamisole was successful in preventing relapse in 19 (29%) patients and was used for median 24 (22 to 25) months. Levamisole was discontinued due to relapse in 25 patients (38%) after median 12 (5-28) months. Side effects occurred in 28 patients (42.4%); the most common side effect was ANCA positivity in 12 patients. In eleven of these patients, levamisole was discontinued; in one patient, low-level titres were documented and spontaneously resolved without cessation of levamisole. Two patients developed ANCA-associated vasculitis. CONCLUSION ANCA positivity is a common side effect of levamisole and was seen in 18.2% of our patients. Monitoring is required to determine side effects including ANCA positivity and treatment modified accordingly.
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Affiliation(s)
- Leah Krischock
- Department of Nephrology, Sydney Children's Hospital, Randwick, NSW, Australia. .,School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia.
| | - Pasan Pannila
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Sean E Kennedy
- Department of Nephrology, Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
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Vermeulen L, Dirix M, Dendooven A. Cocaine Consumption and Antineutrophil Cytoplasmic Antibody-associated Glomerulonephritis: A Case Report. Am J Forensic Med Pathol 2021; 42:198-200. [PMID: 33186130 DOI: 10.1097/paf.0000000000000618] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Cocaine is often sold in a mixture with levamisole to increase the profit margin and potentiate the euphoric effect. Apart from an overdose, cocaine can induce a wide range of clinical symptoms. We present a case of cocaine/levamisole-induced pauci-immune glomerulonephritis. A 22-year-old patient was sent to the hospital after a laboratory result showed an unexpected acute kidney injury, with an estimated glomerular filtration rate of 34 mL/min/1.73 m2. The medical history included cocaine abuse. Renal biopsy showed a pauci-immune necrotizing glomerulonephritis. Antineutrophil cytoplasmic antibodies were positive with a perinuclear staining pattern and target specificity for leucocyte myeloperoxidase (antimyeloperoxidase). Despite treatment, the kidney function did not show significant improvement. The forensic implication of this case is that even if the toxicological values are not high enough to suggest a lethal intoxication, an idiosyncratic reaction on cocaine and/or levamisole has to be taken into account.
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Immunopathogenesis of ANCA-Associated Vasculitis. Int J Mol Sci 2020; 21:ijms21197319. [PMID: 33023023 PMCID: PMC7584042 DOI: 10.3390/ijms21197319] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/26/2020] [Accepted: 09/30/2020] [Indexed: 12/11/2022] Open
Abstract
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis is an autoimmune disorder which affects small- and, to a lesser degree, medium-sized vessels. ANCA-associated vasculitis encompasses three disease phenotypes: granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA). This classification is largely based on clinical presentations and has several limitations. Recent research provided evidence that genetic background, risk of relapse, prognosis, and co-morbidities are more closely related to the ANCA serotype, proteinase 3 (PR3)-ANCA and myeloperoxidase (MPO)-ANCA, compared to the disease phenotypes GPA or MPA. This finding has been extended to the investigation of biomarkers predicting disease activity, which again more closely relate to the ANCA serotype. Discoveries related to the immunopathogenesis translated into clinical practice as targeted therapies are on the rise. This review will summarize the current understanding of the immunopathogenesis of ANCA-associated vasculitis and the interplay between ANCA serotype and proposed disease biomarkers and illustrate how the extending knowledge of the immunopathogenesis will likely translate into development of a personalized medicine approach in the management of ANCA-associated vasculitis.
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Weng CH, Liu ZC. Drug-induced anti-neutrophil cytoplasmic antibody-associated vasculitis. Chin Med J (Engl) 2019; 132:2848-2855. [PMID: 31856057 PMCID: PMC6940077 DOI: 10.1097/cm9.0000000000000539] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE In recent years, an increasing number of drugs have been proved to be associated with the induction of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). This article reviews the latest research progress on drug-induced AAV. DATA SOURCES We conducted a comprehensive and detailed search of the PubMed database. The search terms mainly included drug-induced, ANCA, and vasculitis. STUDY SELECTION We summarized the original articles and reviews on drug-induced AAV in recent years. The extracted information included the definition, epidemiology, associated drugs, pathogenesis, clinical features, diagnosis, treatment, and prognosis of drug-induced AAV. We also focused on the differences between drug-induced AAV and primary vasculitis. RESULTS The offending drugs leading to drug-induced AAV are almost from pharmacologic categories and we need to be vigilant when using these drugs. The pathogenesis of drug-induced AAV might be multifactorial. The formation of neutrophil extracellular traps is an important mechanism for the development of drug-induced AAV. The clinical features of drug-induced AAV are similar to those of primary AAV. Understanding the difference between drug-induced AAV and primary AAV is helpful to identify drug-induced AAV. Stopping the offending drug at once after diagnosis may be sufficient for those patients with mild symptoms. Immunosuppressive therapy should only be used in patients with vital organs involvement. CONCLUSIONS Patients with drug-induced AAV usually have a good prognosis if they stop using the offending drug immediately. Recent advances in research on AAV are expected to help us better understand the pathogenesis of drug-induced AAV.
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Affiliation(s)
- Cheng-Hua Weng
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
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