{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T00:15:09Z","timestamp":1792800909498,"version":"4.5.0"},"reference-count":18,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,8,5]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>Levamisole, a synthetic imidazothiazole derivative, remains a cornerstone in the management of frequently relapsing nephrotic syndrome and steroid-dependent nephrotic syndrome in resource-limited settings. While its efficacy as a steroid-sparing agent is well-established, its safety profile is complicated by rare but severe autoimmune phenomena. We present two distinct paediatric cases of levamisole-induced vasculitis from India.<\/jats:p>\n                  <jats:p>The first case involves a female child in middle childhood who developed multisystemic vasculitis (pulmonary, renal and cutaneous) following an accidental dose escalation. The second involves a female child, also in middle childhood, who developed a similar phenotype after prolonged, stable therapy. Both cases were marked by the presence of anti-neutrophil cytoplasmic antibody and resolved promptly on drug withdrawal. These cases underscore that levamisole-induced autoimmunity is not confined to specific ethnicities or illicit drug contaminants but is a direct iatrogenic risk that clinicians must monitor closely in the paediatric population.<\/jats:p>","DOI":"10.1136\/bcr-2026-272260","type":"journal-article","created":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T12:15:13Z","timestamp":1788610513000},"page":"e272260","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Levamisole-induced anti-neutrophil cytoplasmic antibodies-associated vasculitis in paediatric nephrotic syndrome: dose-dependent and idiosyncratic risks in paediatric patients"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2374-7740","authenticated-orcid":false,"given":"Neha Thakur","family":"Rai","sequence":"first","affiliation":[{"name":"Pediatrics, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Narendra","family":"Rai","sequence":"additional","affiliation":[{"name":"Pediatrics, Child Care, Lucknow, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,5]]},"reference":[{"key":"2026090505150784000_19.9.e272260.1","doi-asserted-by":"crossref","DOI":"10.3390\/jcm8060860","article-title":"Levamisole in Children with Idiopathic Nephrotic Syndrome: Clinical Efficacy and Pathophysiological Aspects","volume":"8","author":"M\u00fchlig","year":"2019","journal-title":"J Clin Med"},{"key":"2026090505150784000_19.9.e272260.2","first-page":"592","article-title":"Evaluation of levamisole, an immunopotentiator, in the treatment of lepromatous leprosy","volume":"58","author":"Kar","year":"1986","journal-title":"Indian J Lepr"},{"key":"2026090505150784000_19.9.e272260.3","doi-asserted-by":"publisher","DOI":"10.1124\/mol.107.044388"},{"key":"2026090505150784000_19.9.e272260.4","first-page":"163","article-title":"Levamisole-induced vasculitis","volume":"26","author":"Abdul-Karim","year":"2013","journal-title":"Proc (Bayl Univ Med Cent)"},{"key":"2026090505150784000_19.9.e272260.5","doi-asserted-by":"crossref","unstructured":"Kidney Disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group. KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases. Kidney Int 2021;100. doi:10.1016\/j.kint.2021.05.021","DOI":"10.1016\/j.kint.2021.05.021"},{"key":"2026090505150784000_19.9.e272260.6","doi-asserted-by":"crossref","first-page":"103505","DOI":"10.1016\/j.jaut.2025.103505","article-title":"Vasculopathy and vasculitis associated with levamisole-adulterated cocaine: a systematic review","volume":"158","author":"Scoglio","year":"2026","journal-title":"J Autoimmun"},{"key":"2026090505150784000_19.9.e272260.7","doi-asserted-by":"crossref","DOI":"10.1186\/s13256-018-1728-6","article-title":"Distinctive vasculopathy with systemic involvement due to levamisole long-term therapy: a case report","volume":"12","author":"Aoun","year":"2018","journal-title":"J Med Case Rep"},{"key":"2026090505150784000_19.9.e272260.8","doi-asserted-by":"crossref","first-page":"1795","DOI":"10.1007\/s00467-020-04915-7","article-title":"Levamisole and ANCA positivity in childhood nephrotic syndrome","volume":"36","author":"Krischock","year":"2021","journal-title":"Pediatr Nephrol"},{"key":"2026090505150784000_19.9.e272260.9","doi-asserted-by":"publisher","DOI":"10.1002\/art.37715"},{"key":"2026090505150784000_19.9.e272260.10","doi-asserted-by":"publisher","DOI":"10.1038\/nrrheum.2016.123"},{"key":"2026090505150784000_19.9.e272260.11","doi-asserted-by":"publisher","DOI":"10.1177\/0394632015617063"},{"key":"2026090505150784000_19.9.e272260.12","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.220089"},{"key":"2026090505150784000_19.9.e272260.13","article-title":"A Review of IgA Vasculitis (Henoch-Sch\u00f6nlein Purpura) Past, Present, and Future","volume":"30","author":"Parums","year":"2024","journal-title":"Med Sci Monit"},{"key":"2026090505150784000_19.9.e272260.14","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/j.abd.2020.01.003","article-title":"Update on vasculitis: an overview and dermatological clues for clinical and histopathological diagnosis - part I","volume":"95","author":"Morita","year":"2020","journal-title":"An Bras Dermatol"},{"key":"2026090505150784000_19.9.e272260.15","doi-asserted-by":"crossref","DOI":"10.1155\/2024\/7388799","article-title":"NETosis Secondary to the Use of Levamisole-Adulterated Cocaine: A Likely Underlying Mechanism of Vasculopathy","volume":"2024","author":"Osorio","year":"2024","journal-title":"J Toxicol"},{"key":"2026090505150784000_19.9.e272260.16","doi-asserted-by":"publisher","DOI":"10.1038\/clpt.1981.154"},{"key":"2026090505150784000_19.9.e272260.17","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1007\/s00467-025-07085-6","article-title":"Prevalence and types of anti-neutrophil cytoplasmic antibodies in patients with nephrotic syndrome treated with levamisole","volume":"41","author":"Singh","year":"2026","journal-title":"Pediatr Nephrol"},{"key":"2026090505150784000_19.9.e272260.18","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1016\/j.semarthrit.2018.07.010","article-title":"Levamisole-induced vasculopathy: A systematic review","volume":"48","author":"Dartevel","year":"2019","journal-title":"Semin Arthritis Rheum"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2026-272260","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T12:15:15Z","timestamp":1788610515000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2026-272260"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":18,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,5]]},"published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1136\/bcr-2026-272260"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2026-272260","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]}}}