Immunostimulatory medications, such as immune checkpoint inhibitors and levamisole, can cause vasculitis, rashes, tissue necrosis, and arthritis. The 5-year outcomes and survival of cocaine-levamisole–induced inflammatory illness were investigated in this prospective cohort research. Thirty-one cocaine-levamisole autoimmune patients and 45 primary vasculitis patients were evaluated in terms of clinical characteristics, antineutrophil cytoplasmic antibody (ANCA) status, therapy, the presence of acute and chronic arthritis, and 5-year prognosis. Seventy-one percent of cocaine-levamisole vasculopathy patients tested positive for ANCA, whereas 53 percent of primary vasculitis cases tested positive for ANCA. At the time of initiation, the ANCA-positive cocaine-levamisole cohort was distinguished by younger age, superficial skin necrosis, low complement C3, antiphospholipid antibodies, neutropenia, and high anti myeloperoxidase (MPO) antibody levels. Chronic cocaine-levamisole illness was characterized by severe facial and extremity cicatricial abnormalities. The two groups had identical arthralgias and acute arthritis. However, a significant number of cocaine-levamisole–induced autoimmune patients developed a chronic deforming inflammatory arthritis that was negative for rheumatoid factor, anti-cyclic-citrullinated antibody, and HLA-B27 but positive for p-ANCA and MPO antibodies.

Patients who have been exposed to cocaine-levamisole may acquire major chronic sequelae, such as cicatricial cutaneous and facial deformities, as well as an unusual seronegative, p-ANCA, and MPO antibody–positive, HLA-B27–negative chronic deforming inflammatory arthritis.

Reference:https://journals.lww.com/jclinrheum/Abstract/2020/01000/Atypical_Chronic_Inflammatory_ANCA_Positive.5.aspx