{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T09:20:33Z","timestamp":1781169633342,"version":"3.54.1"},"reference-count":50,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,6,6]],"date-time":"2023-06-06T00:00:00Z","timestamp":1686009600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmaceuticals"],"abstract":"<jats:p>Levamisole is an anti-helminthic drug with immunomodulatory properties that is added to cocaine to increase its potency and weight. Levamisole-adulterated cocaine (LAC) may cause an antineutrophil cytoplasmic antibody (ANCA)-associated systemic small vessel vasculitis (AAV). We aimed to characterize the phenotype of persons developing pulmonary-renal syndrome (PRS) in LAC-induced AAV and summarize its treatment and outcomes. Pubmed and Web of Science were searched (until September 2022). Reports that described co-existing diffuse alveolar hemorrhage and glomerulonephritis in an adult (age \u2265 18) with confirmed or suspected LAC exposure were included. Reports, demographics, clinical and serologic features, treatment and outcome characteristics were extracted. Of the 280 records identified, eight met the inclusion criteria, including eight unique cases. Persons were aged 22\u201358 years, and 50% were women. Cutaneous involvement occurred in only half of the cases. Other associated vasculitis findings and serologies were heterogeneous. All patients received immunosuppression with steroids, with cyclophosphamide and rituximab commonly added. We concluded that PRS could occur from LAC-induced AAV. Distinguishing LAC-induced AAV from primary AAV is challenging as clinical and serologic presentations overlap. Asking about cocaine use is requisite in persons presenting with PRS to guide diagnosis and appropriately counsel on cocaine cessation in conjunction with immunosuppression as treatment.<\/jats:p>","DOI":"10.3390\/ph16060846","type":"journal-article","created":{"date-parts":[[2023,6,7]],"date-time":"2023-06-07T02:02:15Z","timestamp":1686103335000},"page":"846","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Pulmonary-Renal Syndrome from Levamisole-Adulterated Cocaine-Induced Antineutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitis: A Systematic Review"],"prefix":"10.3390","volume":"16","author":[{"given":"Philip","family":"Bucur","sequence":"first","affiliation":[{"name":"Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA"},{"name":"Charlie Norwood Veterans Affairs Medical Center, Augusta, GA 30901, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marshall","family":"Weber","sequence":"additional","affiliation":[{"name":"Medical College of Georgia, Augusta University, Augusta, GA 30912, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rashi","family":"Agrawal","sequence":"additional","affiliation":[{"name":"Medical College of Georgia, Augusta University, Augusta, GA 30912, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adria Irina","family":"Madera-Acosta","sequence":"additional","affiliation":[{"name":"Mayo Clinic Health System, Luther Campus Clinic, Eau Claire, WI 54703, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9927-6063","authenticated-orcid":false,"given":"Rachel E.","family":"Elam","sequence":"additional","affiliation":[{"name":"Charlie Norwood Veterans Affairs Medical Center, Augusta, GA 30901, USA"},{"name":"Division of Rheumatology, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,6,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1016\/0192-0561(92)90179-O","article-title":"Levamisole, the story and the lessons","volume":"14","author":"Amery","year":"1992","journal-title":"Int. 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