Abstract
Cocaine- and levamisole-induced vasculitis (CLIV) is a distinct form of drug-induced vasculitis characterized by dual antineutrophil cytoplasmic antibody (ANCA) positivity, rapidly progressive glomerulonephritis (RPGN), and diffuse alveolar hemorrhage (DAH). This systematic review synthesizes data from case reports, case series, and reviews published between 2015 and 2024 to clarify clinical presentations, diagnostic approaches, and management strategies. A comprehensive search of PubMed and Google Scholar using terms such as "levamisole-induced vasculitis," "cocaine-associated vasculitis," "dual ANCA vasculitis," "RPGN," and "DAH" identified 312 records. After removing 84 duplicates, 228 records were screened, 52 were assessed for eligibility, and 18 were included in the final analysis. Most patients presented with cutaneous, renal, and pulmonary involvement. Diagnostic tools included ANCA serology (MPO and PR3), biopsy, and imaging. Treatment most often involved corticosteroids, with severe cases requiring rituximab, cyclophosphamide, or plasmapheresis. Prognosis improved with early diagnosis and cessation of exposure. Recognition of CLIV in cocaine users presenting with ANCA-positive vasculitis is essential for early intervention and improved outcomes.