Vasculite induzida por cocaína/levamisol: uma revisão bibliográfica

Abstract

Levamisole-associated vasculitis is a rare and complex condition, usually diagnosed in individuals who use cocaine adulterated with this agent. Levamisole, originally developed as an antiparasitic and immunomodulatory drug, was widely used in veterinary and human medicine before its withdrawal from the market for human use due to significant adverse effects. Despite this, it has been identified as a substance commonly mixed with cocaine, due to its low cost and ability to potentiate the stimulant effects of the drug. Clinically, levamisole-associated vasculitis presents heterogeneous manifestations, including necrotizing skin lesions, retiform purpura, arthralgia, fever and agranulocytosis. Its presentation can be severe, often confused with other primary vasculitides, such as granulomatosis with polyangiitis, due to the presence of antineutrophil cytoplasmic antibodies (ANCA), especially against myeloperoxidase (MPO) and proteinase 3 (PR3), which may be simultaneously positive in these patients. This paper aims to explore recent updates on the pathogenesis of this disease, discussing the possible immunological mechanisms involved, such as the interaction between levamisole and the immune system, which can trigger a dysregulated autoimmune response. In addition, a review of the characteristic symptoms of this condition will be made, highlighting the need for an accurate diagnosis to differentiate levamisole-associated vasculitis from other primary and secondary vasculitides, given its relevance in clinical management. Finally, the importance of recognizing this entity as an emerging complication of adulterated cocaine use will be highlighted, considering the increase in case reports in several countries.