LEVAMISOLE-INDUCED ANCA VASCULITIS OVERLAP SYNDROME

TOPIC: Pulmonary Manifestations of Systemic Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Levamisole is a contaminant present in street cocaine. It has been associated with number clinical side effects, including vasculitis. We case patient acute pulmonary, cutaneous and Musculoskeletal symptoms following cocaine use who was found to have an overlap features Granulomatosis Polyangiitis (GPA) Eosinophilic (EGPA). CASE PRESENTATION: A 31 year old male no past medical history presented fatigue, polyarthralgia, generalized body ache scattered blisters over the upper lower extremities. Days prior presentation, he used injected His vital signs were notable for tachycardia (140s). Exam swollen hand joints, scabbed lesions arms legs. WBC 21 Absolute Eosinophil count 8.23 . Serum IgE 1500. Urine toxicology positive metabolites. CXR showed multiple bilateral infiltrates. During hospitalization, continued severe polyarthralgia. He developed worsening cough small volume hemoptysis. CT chest patchy peripheral Bronchoscopy Bronchoalveolar Lavage (BAL) revealed bloody secretions not meeting criteria DAH. BAL sample had 107 cells 80% eosinophils. Extensive infectious, hypersensitivity autoimmune workup sent. Results returned C-ANCA Anti-PR3. underwent left lung wedge biopsy which Active Interstitial Pneumonitis marked intra-alveolar interstitial eosinophilia that more consistent Polyangiitis. This lead diagnosis syndrome GPA EGPA likely induced. DISCUSSION: Our illustrates drug induced systemic ANCA vasculitis (EGPA) synthetic imidazothiazole analogue immunomodulatory properties. currently being as anthelmintic agent veterinary medicine. frequent effects Pulmonary, musculoskeletal manifestations after use. Elevated along presence eosinophilia, elevation tissue finding eosinophilic pneumonitis GPA/EGPA syndrome. Rare reports similar rported but none CONCLUSIONS: highlights importance considering substance induce Autoimmune conditions patients presenting multisystem pulmonary involvement. can variable manifestations. REFERENCE #1: Lee KC, Ladizinski B, Federman DG. Complications levamisole-contaminated cocaine: emerging public health challenge. Mayo Clin Proc. 2012 Jun;87(6):581-6. #2: DISCLOSURES: No relevant relationships by Alissa Ali, source=Web Response Ahmed Hussin,