Methamphetamine‐induced renal pseudovasculitis: Suspicion is
The following case appears in the journal Clinical Case Reports. A 38‐year‐old man presented with generalized weakness and epigastric pain. Examination revealed several pustules and purpuric spots on his legs, which he attributed to insect bites. Urine drug screen was positive for amphetamines and serum creatinine was 1.4 mg/dL.

He soon developed sepsis with respiratory failure requiring mechanical ventilation and acute kidney injury requiring dialysis. Serum creatine kinase was within normal limits. Viral hepatitis and HIV testing, and vasculitis work up including antinuclear antibodies, antineutrophil cytoplasmic antibodies, and cryoglobulins were negative.

Skin biopsy revealed evidence of mild vascular damage with swollen endothelial cells and infiltrate of neutrophils, eosinophils suggesting vasculitis. Renal biopsy demonstrated acute tubular injury and transmural fibroid necrosis without significant neutrophilic infiltrate in a medium‐sized vessel and 2 branch vessels suggestive of subacute vasculitis, likely related to drug abuse. Patient's renal function gradually improved during the course of hospitalization and was taken off dialysis.

Key clinical message:-
• It is important to recognize drug‐induced vasculitis as patients with true vasculitis often require immunosuppressive therapy and delay in treatment can result in significant mortality.

• Illicit drug use (specifically methamphetamine and cocaine) should be in the differential diagnosis of vasculitis as it typically resolves with cessation of the drug.

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