Some people who abuse drugs may develop a drug-related vasculitis. This may be an immune response to the drug or to contaminants.
Drugs associated with vasculitis may include heroin, methamphetamines and cocaine.
When to suspect drug-related vasculitis:
(1) clinical signs and symptoms consistent with vasculitis (stroke, skin lesions, kidney disease, etc)
(2) clinical signs and symptoms in periods when drug levels are very low or negative (periods of abstinence)
(3) lymphadenopathy with lymphoid hyperplasia
(4) evidence of polyarteritis-like lesions on angiography
(5) eosinophilia
(6) positive direct antiglobulin test
(7) elevated concentrations of serum immunoglobulins
(8) false positive serology tests
(9) necrotizing angiitis on biopsy
(10) lymphocytic perivasculitis with eosinophils on biopsy
Diagnosis requires exclusion of other causes of immune vasculitis such as viral hepatitis C.
The diagnosis is supported by:
(1) improvement on complete drug abstinence and recurrence on drug exposure.
(2) demonstration of antibodies to the drug or drug additives if available.
