Periocular manifestations of cocaine associated PR3 positive vasculitis
Author: Alexander Mitchell
Base Hospital / Institution: Manchester Royal Eye Hospital
ePoster presentation
Abstract ID: 25-292
Purpose
To raise awareness of rare but severe periocular manifestations of cocaine misuse which can result in drug-induced vasculitis which mimics granulomatosis with polyangiitis (GPA). This typically presents with rhinitis with nasal tissue necrosis. ANCA with PR3 is positive in 70% of cases.
Methods
We present a case series of 3 patients managed with ocular complications of PR3 cocaine-induced vasculitis
Results
A 42-yr-old male: left sided epiphora and inflamed medial canthus. PR3 vasculitis involving left orbit, lacrimal drainage system and nose. Orbital and nasal biopsies showed vasculitis and necrosis. Cocaine cessation attempted but failed. Recurrent bouts of ocular and periocular inflammation. Disease controlled with steroids and rituximab.
A 33-year-old male: recurrent episodes of left orbital cellulitis with medial orbit inflammation. Nasal collapse due to cocaine-induced PR3 vasculitis with extension into the inferomedial orbit. Numerous attempts to cease cocaine use including voluntary residential rehab. Ultimately his PR3 positivity reversed, and disease became quiescent only after he relocated to escape his drug-fuelled environment.
A 57-year-old female chronic cocaine user with delayed presentation of progressive left optic neuropathy and severe visual loss secondary to cocaine-induced osteolytic sinusitis with orbital apex involvement. Biopsy-proven nasal and paranasal sinus vasculitis and necrosis. Unable to cease cocaine use and declined treatment initially but showed some improvement in visual field with IV and oral methylprednisolone.
Conclusion
These 3 cases describe the significant challenges in managing the rare but severe debilitating consequences of cocaine-induced vasculitis, despite coordinated MDT care (rheumatology, ENT and ophthalmology). PR3 positivity often correlates with disease activity and degree of cocaine misuse. Cocaine cessation might not succeed in a timely manner so aggressive immunosuppression may be required to control disease progression in such cases.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Namita | Matthews | Manchester Royal Eye Hospital |
| Adam | Bull | Manchester Royal Eye Hospital |
| Saj | Ataullah | Manchester Royal Eye Hospital |
