A case report on suspected levamisole-induced pseudovasculitis

Tiffany Fan, Jeffrey Macaraeg, Toufik Mahfood Haddad, Holly Bacon, Duc Le, Mohsin Mirza, Carrie Valenta, Tammy O Wichman

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Introduction: Levamisole-induced pseudovasculitis should be considered in patients with inconsistent anti-neutrophil cytoplasmic antibodies (ANCA) pattern and history of cocaine use. Case Presentation: A 50-year-old man presented to the emergency department with symptoms of bilateral pulmonary emboli. His hospital course was complicated by multiple end organ failure, which improved dramatically with prednisone. Although he was diagnosed previously with granulomatosis with polyangiitis due to positive proteinase 3 (PR3), myeloperoxidase (MPO), perinuclear anti-neutrophil cytoplasmic antibodies (P-ANCA) and cytoplasmic anti-neutrophil cytoplasmic antibodies (C-ANCA) markers, his longstanding cocaine use and history of skin ulcers, thrombotic events, and febrile illnesses suggested a diagnosis of levamisole-induced pseudovasculitis instead. Discussion: Differentiating between vasculitides can be challenging due to similar clinical and laboratory findings. To differentiate the two, biopsies should be obtained. The absence of granu-lomas or leukocytoclasia, and the presence of vasculopathic purpura, should guide clinicians toward pseudovasculitis. Conclusion: It is important to maintain a high index of suspicion for pseudovasculitis because long-term corticosteroid use to treat granulomatosis with polyangiitis can lead to detrimental effects.

Original languageEnglish (US)
Pages (from-to)37-39
Number of pages3
JournalWisconsin Medical Journal
Volume116
Issue number1
StatePublished - Feb 1 2017
Externally publishedYes

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Levamisole
Antineutrophil Cytoplasmic Antibodies
Granulomatosis with Polyangiitis
Cocaine
Myeloblastin
Skin Ulcer
Purpura
Multiple Organ Failure
Vasculitis
Prednisone
Embolism
Peroxidase
Hospital Emergency Service
Adrenal Cortex Hormones
Fever
Biopsy
Lung

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Fan, T., Macaraeg, J., Haddad, T. M., Bacon, H., Le, D., Mirza, M., ... Wichman, T. O. (2017). A case report on suspected levamisole-induced pseudovasculitis. Wisconsin Medical Journal, 116(1), 37-39.

A case report on suspected levamisole-induced pseudovasculitis. / Fan, Tiffany; Macaraeg, Jeffrey; Haddad, Toufik Mahfood; Bacon, Holly; Le, Duc; Mirza, Mohsin; Valenta, Carrie; Wichman, Tammy O.

In: Wisconsin Medical Journal, Vol. 116, No. 1, 01.02.2017, p. 37-39.

Research output: Contribution to journalArticle

Fan, T, Macaraeg, J, Haddad, TM, Bacon, H, Le, D, Mirza, M, Valenta, C & Wichman, TO 2017, 'A case report on suspected levamisole-induced pseudovasculitis', Wisconsin Medical Journal, vol. 116, no. 1, pp. 37-39.
Fan T, Macaraeg J, Haddad TM, Bacon H, Le D, Mirza M et al. A case report on suspected levamisole-induced pseudovasculitis. Wisconsin Medical Journal. 2017 Feb 1;116(1):37-39.
Fan, Tiffany ; Macaraeg, Jeffrey ; Haddad, Toufik Mahfood ; Bacon, Holly ; Le, Duc ; Mirza, Mohsin ; Valenta, Carrie ; Wichman, Tammy O. / A case report on suspected levamisole-induced pseudovasculitis. In: Wisconsin Medical Journal. 2017 ; Vol. 116, No. 1. pp. 37-39.
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