Drugs which induce ANCA vasculitis
What drugs have been implicated in inducing ANCA vasculitis?
The development of vasculitis with ANCAs has been associated with many agents.
The most commonly implicated drug is the anti-thyroid medication, propothiouracil (PTU), with other thyroid agents, including methimazole and carbimazole, also implicated.
Other agents reported to be associated with ANCA vasculitis include hydralazine, minocycline, allopurinol, phenytoin, and penicillamine, among others. Both PTU and hydralazine are typically associated high-titer MPO antibodies, and the latter also with antibodies directed to elastase and lactoferrin.
Withdrawal of the offending agent is, at times, sufficient to prompt resolution of the vasculitis, while, in some instances, immunosuppressive therapy is necessary, depending on the severity of the presentation.
Levamisole, originally utilized as an anti-helminthic, has been used as an adulterant to “cut” cocaine.
Reports of vasculitis associated with the use of this agent have emerged over the last decade with a severe presentation of vasculitis that may also present with necrotizing skin lesions, glomerulonephritis, or pulmonary hemorrhage.
Patients with levamisole-associated ANCA vasculitis may often be “dual positive” for both MPO- and PR3-ANCA.
