Cocaine-Induced Granulomatosis With Polyangiitis Described

TUESDAY, April 4, 2023 (HealthDay News) -- Young patients with destructive nasal lesions commonly have current cocaine use, according to a study published online April 4 in Rheumatology Advances in Practice.

Charn Gill, from the University of Birmingham in the United Kingdom, and colleagues conducted a retrospective case series analysis of patients presenting with cocaine-induced midline destructive lesions or vasculitis compatible with granulomatosis with polyangiitis (GPA) between 2016 and 2021. A total of 42 patients (median age, 41 years) were identified with cocaine-induced midline lesions or systemic disease.

The researchers found that current cocaine use was common; when routine urine toxicology was performed, 20 of 23 samples provided were positive. Based on a urine toxicology analysis, nine patients who denied ever using cocaine were identified as users and 11 tested positive despite stating that they were ex-users. High incidences of septal perforation and oronasal fistula were seen (75 and 15 percent, respectively). Systemic manifestations were seen in 27 percent of participants, and only one had acute kidney injury. Of the patients, 56 percent were PR3-ANCA positive and none tested positive for MPO-ANCA. Even when immunosuppression was administered, symptom remission required cocaine discontinuation.

"We now include urine samples for drugs of abuse in our initial investigations of patients with GPA and in those who appear not to be responding to treatment. Sadly, we have seen young people with life-changing disfigurement because of cocaine-induced granulomatosis with polyangiitis," a coauthor said in a statement. "A better understanding of this condition prevents us from potentially harming patients further by administering inappropriate, potentially toxic, and futile treatment."

Abstract/Full Text