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It was created in December with the purpose of disseminating scientific information derived from primary and secondary research and presenting cases coming from the practice of Rheumatology in Latin America. Since its foundation, the Journal has been characterized by its plurality with subjects of all rheumatic and osteomuscular pathologies, in the form of original articles, historical articles, economic evaluations, and articles of reflection and education in Medicine. It covers an extensive area of topics ranging from the broad spectrum of the clinical aspects of rheumatology and related areas in autoimmunity both in pediatric and adult pathologies , to aspects of basic sciences. It is an academic tool for the different members of the academic and scientific community at their different levels of training, from undergraduate to post-doctoral degrees, managing to integrate all actors inter-and transdisciplinarily. It is intended for rheumatologists, general internists, specialists in related areas, and general practitioners in the country and abroad. It has become an important space in the work of all rheumatologists from Central and South America. SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact. SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field. Cocaine use is associated with several rheumatic syndromes. A series of cases is presented of 10 patients 7 male and 3 female , age at onset: 19—38 years-old. They consulted due to a variety of symptoms: fever, arthritis, swollen hands, stroke, fetal losses, arterial hypertension, alveolar hemorrhage, leucocytoclastic vasculitis, genital bleeding, among others. Treatments with steroids in bolus, cyclophosphamide and rituximab were used, with a good response. This series highlights clinical manifestations at onset that can mimic primary rheumatic diseases. Rheumatologists should consider cocaine use in the differential diagnoses of vasculitis and pseudovasculitis syndromes.. Fueron tratados con corticoides intravenosos en bolo, ciclofosfamida y rituximab, con buena respuesta. Substance abuse is common in some communities and can mimic rheumatic syndromes and vasculitis. In fact, cocaine is a substance that has been associated to the immune response and also with the presence of a variety of syndromes, symptoms and antibodies, such as thrombocytopenia, hemolytic anemia, necrotizing vasculitis, pulmonary hemorrhage, acute renal failure, hemorrhagic stroke, antinuclear antibodies ANA , antineutrophil cytoplasmic antibodies ANCA and antiphospholipid antibodies. Thus, a high clinical suspicion and the knowledge of manifestations secondary to the use of recreational drugs will avoid extensive studies, unnecessary hospitalizations and therapeutic mistakes. In this report, we describe 10 cases of patients with clinical, immune and laboratory manifestations that were associated with cocaine addiction. This association was confirmed when the patients admitted its use mostly snorting , when the patient's kin revealed the patient's addiction or when cocaine or its metabolites could be measured in urine. Case 1: A year-old male cnsulted for erythematous and swollen hands and feet, burning ensation, right Achilles enthesis, cutaneous psoriasis, lymphopenia, eosinophilia and increased titer of CRP. Psoriatic arthropathy was suspected and the patient received anti-inflammatory drugs, without improvement. Of note, the patient started symptoms following cocaine snort. He improved when he quit the use of cocaine. Leucocytoclastic vasculitis: fibrin in wall vessel and neutrophilic nuclear dust. Later on, the family found cocaine within patient's personal belongings. After improving, the patient did not return to control. Case 3: A year-old-woman was hospitalized due to ischemic cerebrovascular attack, with motor involvement, two fetal looses, arterial hypertension, aortic aneurysm and renal impairment. Lab results showed the presence of eosinophilia, positive anticardiolipins and Beta 2 glycoprotein I. An antiphospholipid syndrome was suspected and the patient received aspirin, enalapril, atenolol and acenocoumarol. Later on, the patient admitted cocaine addiction. The patient was discharged with a 3 days-dialysis plan and after 18 months of follow-up, she did not return to a rheumatologic control. Case 4: A year-old woman came to the emergency room due to shortness of breath, hemoptysis and genital bleeding. Personal history: hyperthyroidism, alcoholism, tobacco and cocaine use during the last 20 years. She presented with fever, petechiae on hard palate and legs, ulcers on nasal septum, liver and spleen enlargement, and ecchymosis. Idiopathic thrombocytopenic purpura was suspected. Bronchoalveolar lavage confirmed the presence of alveolar hemorrhage, so she was treated with intravenous gammaglobulin, methylprednisone and cyclophosphamide with partial response. The patient developed a cerebrovascular accident in left temporal lobe, with intracranial bleeding. After 2 years of follow-up, the patient did not return to a control visit Fig. Case 5: A year-old male who came to consultation with bleeding gums, fever, testicular pain, purpuric lesions in lower limbs and hematuric urine. Renal biopsy: mesangiocapillary glomerulonephritis with IgG and IgM deposits. Suspected diagnosis: polyarteritis nodosa and vasculitis secondary to cocaine addiction. He was treated with steroids in bolus and intra-venous cyclophosphamide. The patient admitted cocaine addiction. After 7 months of treatment, the patient developed obstructive respiratory failure due to tonsil enlargement Candida infection and died. Case 6: A year-old male who was hospitalized because of weight loss, arthritis, fever, nasal septum perforation, polyserositis, ear necrosis, alveolar hemorrhage, and proliferative extracapilar glomerulonephritis with fibrous crescents with IgM deposits. Systemic lupus erythematosus and vasculitis were suspected and the patient received steroids in bolus and intravenous cyclophosphamide. The symptoms of the patient improved. Later on, he admitted the addiction to cocaine since he was 15 years-old. Case 7: A year-old male came to consultation with arthralgias and morning stiffness of 30 min. With a suspected diagnosis of rheumatoid arthritis, vasculitis or systemic lupus erythematosus, anti-inflammatory drugs were started. The patient returned to consultation after 4 months with hemoptysis and admitting his addiction to cocaine. Alveolar hemorrhage was confirmed by bronchoalveolar lavage. He was hospitalized and received steroids in bolus and intravenous cyclophosphamide and after 2 years of treatment the patient improved. Case 8: A year-old male addict to cocaine since 4 years ago consulted for fever, arthalgias, myalgias, arthritis, nasal septum perforation, lymph node, liver and spleen enlargement and subcutaneous nodules. Systemic lupus erythematosus and vasculitis secondary to cocaine addiction were suspected. The patient quit the habit to consume cocaine; hydroxychloroquine and diclofenac were administrated and his symptoms improved. He did not return to control after 18 months of follow-up. Case 9: A year-old woman hospitalized because of cheek purpuric lesions, cutaneous and ear necrosis, spleen enlargement, fever and alveolar hemorrhage. Skin biopsy: cutaneous vasculitis with IgM and complement deposits. Systemic lupus erythematosus and cryoglobulinemic vasculitis were considered, so steroids in bolus and intravenous cyclophosphamide were administered with good results. Later on, the patient admitted cocaine addiction and the urine test was positive for cocaine. After 6 months of treatment, the patient was lost of follow-up Figs. Case A year-old male, alcoholic, addict to cocaine, with cutaneous psoriasis on physical exam and fracture of tibia and fibula that later on developed osteomyelitis, was hospitalized due to headache, fever, arthritis, dyspnea, hemoptoic sputum and pulmonary bilateral infiltration in tomographic scan of thorax. Due to the presence of arthritis and cutaneous psoriasis, a peripheral spondyloarthritis was suspected. Pulmonary thromboembolism and infections were ruled out. An alveolar hemorrhage was confirmed by bronchoalveolar lavage and the patient was treated with high doses of steroids with good response. He also quit the habit of cocaine consumption. Drug addiction is common in many communities and causes significant morbidity and mortality specially associated to harmful physiopathological effects of the substance itself but also by its adulterants. The preferred drug among Argentinian users is cocaine inhaled. Its impact has been described as a social consequence of the financial, political and social crisis that lead large numbers of Argentinians to poverty and marginal status. According to epidemiologic data the use of cocaine is more frequent among males than females and among 12—24 year-old individuals than in other age groups, 7 similar to what was observed in our patients. This ANCA shares sequence and structural homology with the classic C-ANCA associated antigen PR-3 and would be present in vasculitis induced by cocaine use, 9 allowing to differentiate between both types of vasculitis. Clinical manifestations depend on the way cocaine is administered the majority of this patients used inhalatory route. The presence of purpuric lesions, thrombocytopenia, neutropenia, elevated erythrosedimentation rate and PCR is attributed to levamisole anthelmintic substance used to adulterate cocaine more than to cocaine itself. Association between levamisole and renal and pulmonary lesions was rarely present. Treatment is supportive but patients should stop their addiction. We could not determine in the present series if patients had quit the use of cocaine, since half of them were lost of follow-up. The majority of them had been treated with I. Rheumatologists should consider cocaine in the differential diagnoses of vasculitis 12 and pseudovasculitis syndromes cholesterol embolia, atrial myxoma, bacterial endocarditis, calciphylaxis, paraneoplastic syndromes, antiphospholipid syndrome, organ transplant rejection, ergot abuse, amyloidosis and fibromuscular dysplasia, among other causes. There is no pharmaceutical or industry support. ISSN: See more Follow us:. Previous article Next article. Issue 4. Pages October - December Export reference. More article options. Case Report. DOI: Rheumatic manifestations associated with cocaine addiction. Download PDF. Susana Roverano. Corresponding author. Cullen, Santa Fe, Argentina. This item has received. Article information. Show more Show less. Rheumatologists should consider cocaine use in the differential diagnoses of vasculitis and pseudovasculitis syndromes. Palabras clave:. Full Text. Introduction Substance abuse is common in some communities and can mimic rheumatic syndromes and vasculitis. Cases Case 1: A year-old male cnsulted for erythematous and swollen hands and feet, burning ensation, right Achilles enthesis, cutaneous psoriasis, lymphopenia, eosinophilia and increased titer of CRP. Palpable purpura in lower limbs. Nasal septum perforation. Cutaneous necrosis in lower limbs. Ear necrosis. Yogarajah, M. Pervil-Ulysse, B. Cocaine-induced delayed recurrent vasculitis: a 4-year follow-up. Am J Case Rep, 16 , pp. Alvi, S. Venkatram, G. Recurrent febrile neutropenia and thrombocytopenia in a chronic cocaine user: a case of levamisole induced complications. Case Rep Crit Care, ,. Curr Opin Rheumatol, 25 , pp. Rivero, M. Argibay, B. Maure, et al. Complications related with cocaine abuse that required hospital admission. Rev Clin Esp, , pp. Subst Use Misuse, 38 , pp. Camarotti, A. Tarragona, C. Doing gender in a toxic world. Women and freebase cocaine in the city of Buenos Aires Argentina. Subst Use Misuse, 50 , pp. Parra Izquierdo, H. Aguirre, N. Agudelo, N. Cuervo, E. Rev Colomb Reumatol, 25 , pp. Fujinaga, M. Chernaia, R. Halenbeck, K. Koths, M. The crystal structure of PR3, a neutrophil serine proteinase antigen of Wegener's granulomatosis antibodies. J Mol Biol, , pp. Lee, J. Stone, D. A year-old woman with cutaneous bullae and extensive skin necrosis. Arthritis Care Res, 62 , pp. McGrath, T. Isakova, H. Rennke, A. Mottola, K. Laliberte, J. Contaminated cocaine and antineutrophil cytoplasmic antibody-associated disease. Clin J Am Soc Nephrol, 6 , pp. Jennette, R. Falk, R. Bacon, P. Bacon, N. Basu, M. Cid, et al. Arthritis Rheum, 65 , pp. Subscribe to our newsletter. Recommended articles. Toxics and atypical manifestations. Vasculitis associated Cervical lymph nodes in rheumatology: A diagnostic Immune thrombocytopenia in adults: Epidemiology, clinical Article options. Download PDF Bibliography. Vasculitis associated with levamisole-adulterated cocaine. A case report.

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