1/Having just finished residency, I am having morning report withdrawals. Thankfully, I was able to tune in yesterday for a great case. .
Reposting my ANCA infographic below. I wanted to take some time to review drugs associated w/ vasculitis w/ + ANCA.
Reposting my ANCA infographic below. I wanted to take some time to review drugs associated w/ vasculitis w/ + ANCA.
2/The morning report pearl is that with dual+ on Elisa ANCA testing (both MPO and PR3) consider a drug-induced vasculitis. When I think about dual + ANCA, levamisole-induced vasculitis comes to mind first.
3/ Levamisole is an antihelminthic agent that is present in up to 60-70% of street cocaine. It can cause a cutaneous vasculitis prominent on the extremities (especially ears and nose). Highest risk is with smoking or snorting cocaine.
4/Vasculitis starts as a painful, purpuric rash that can progress to necrosis. MPO is + approx 100% and dual + 50% (ANA and APL antibody can also be +). Levamisole is also associated with agranulocytosis.
Image source: ncbi.nlm.nih.gov/pmc/articles/P…
Image source: ncbi.nlm.nih.gov/pmc/articles/P…
5/Common drugs associated w/ ANCA-associated vasculitis (AAV) are hydralazine, minocycline, and PTU/methimazole which are associated w/ high MPO-ANCA titers, may have antibodies to elastase or lactoferrin, hydralazine also +ds-DNA antibodies. Rarely double ANCA + is present.
6/Hydralazine-induced ANCA vasculitis can present with lung and renal manifestations. Other reported meds associated w/ AAV: TNF-a inh, allopurinol, sulfasalazine, Phenytoin, and clozapine are also reported.
