{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T16:58:06Z","timestamp":1792515486507,"version":"4.5.0"},"reference-count":20,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T00:00:00Z","timestamp":1750118400000},"content-version":"vor","delay-in-days":16,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Immunity Inflam &amp;amp; Disease"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Cocaine\/Levamisole\u2010Associated Autoimmune Syndrome (CLAAS) encompasses a spectrum of autoimmune and vasculitic phenomena, which includes Cocaine\u2010Induced Midline Destructive Lesions (CIMDL), which can mimic ANCA\u2010associated vasculitis (AAV) due to overlapping clinical features and the potential for ANCA positivity. These similarities can lead to misdiagnosis and inappropriate immunosuppressive therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study highlights a case series of seven patients (from 2015 to 2024) with CLAAS with its subset of CIMDL, initially misdiagnosed as active AAV, in patients who were referred to various clinicians in the Rheumatology unit of a Tertiary Hospital in the United Kingdom.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All patients presented with nasal symptoms, and they all exhibited additional systemic manifestations consistent with CLAAS. Five were ANCA\u2010positive at initial evaluation, leading to the initiation of immunosuppressive therapy; however, symptoms persisted. The diagnoses were then revised to CIMDL in all cases within the broader context of CLAAS following the identification of cocaine use after further patient inquiry and urine toxicology for drug of abuse (DOA) screening found cocaine metabolites.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>A comprehensive drug history and urine toxicology screening are crucial in patients with suspected AAV, as ANCA positivity can occur in CLAAS as well as its subset of CIMDL, complicating the diagnosis. Differentiating between AAV and CIMDL related to CLAAS is essential to avoid unnecessary immunosuppression.<\/jats:p><\/jats:sec>","DOI":"10.1002\/iid3.70215","type":"journal-article","created":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T08:42:10Z","timestamp":1750149730000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Misdiagnosis of ANCA\u2010Associated Vasculitis in Patients With Cocaine\/Levamisole\u2013Associated Autoimmune Syndrome and Cocaine\u2010Induced Midline Destructive Lesions: A Case Series"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4824-1340","authenticated-orcid":false,"given":"Kehinde","family":"Sunmboye","sequence":"first","affiliation":[{"name":"University of Leicester Leicester UK"},{"name":"University Hospitals of Leicester Leicester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ameen","family":"Jubber","sequence":"additional","affiliation":[{"name":"University Hospitals of Leicester Leicester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maumer","family":"Durrani","sequence":"additional","affiliation":[{"name":"University Hospitals of Leicester Leicester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy","family":"Royle","sequence":"additional","affiliation":[{"name":"University Hospitals of Leicester Leicester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shireen","family":"Shaffu","sequence":"additional","affiliation":[{"name":"University Hospitals of Leicester Leicester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,6,17]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/iop.0000000000002347"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/rap\/rkad027"},{"issue":"4","key":"e_1_2_11_4_1","first-page":"568","article-title":"Levamisole\u2010Adulterated Cocaine Causing ANCA\u2010Associated Vasculitis and Pauci\u2010Immune Glomerulonephritis: A Case Report and Literature Review","volume":"58","author":"McGrath M. 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J.","year":"2022","journal-title":"Journal of Allergy and Clinical Immunology"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1017\/s0022215120000894"},{"key":"e_1_2_11_10_1","first-page":"145","article-title":"Differentiating ANCA\u2010Associated Vasculitis From Cocaine\u2010Induced Lesions: A Diagnostic Conundrum","volume":"158","author":"Pendolino A. 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V.","year":"2015","journal-title":"Journal of Nephrology"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/1940-0640-7-19"},{"issue":"6","key":"e_1_2_11_16_1","first-page":"580","article-title":"Urine Toxicology Screening In Patients Suspected of Anca\u2010Associated Vasculitis: A Missed Opportunity","volume":"52","author":"Lawrence D. 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