Rheumatic Manifestations of Cocaine Use

Jonathan Graf


Curr Opin Rheumatol. 2013;25(1):50-55. 

In This Article


Cocaine use is associated with a wide variety of clinical manifestations that can be difficult to distinguish from idiopathic autoimmune rheumatic diseases. Similarly to patients with idiopathic disease, those with cocaine-associated rheumatic diseases will often, but not always, be ANCA positive; however, the titre and specificities of ANCA may help to distinguish between these different entities. Increased use of levamisole to adulterate cocaine has resulted in a well reported syndrome with features of neutropenia, retiform purpura and cutaneous necrosis (with a predilection for the ear lobes and cheeks), and autoantibodies consisting of high-titre p-ANCA with specificities for 'atypical' antigens including HNE. In light of the widespread use of cocaine and its prevalent adulteration with levamisole, clinicians should be familiar with the clinical manifestations of these diseases.