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25 February 2020 : Case report  Brazil

Cocaine-Induced Renal Artery Dissection as a Cause of Secondary Hypertension: A Rare Presentation

Challenging differential diagnosis, Rare disease

Wallace Stwart C. Padilha1ABCDEF*, Marcelo Annes2BCD, Cristina G. Massant2BCD, Alexandre O. Kaup2BCD, Breno B. Affonso3BCD, Marcelo C. Batista124ABCDE

DOI: 10.12659/AJCR.921565

Am J Case Rep 2020; 21:e921565

Abstract

BACKGROUND: Cocaine abuse is a globally recognized problem with great socioeconomic and health impacts on society. We report a case of dissection of vertebral arteries and right renal artery after cocaine abuse that clinically presented as atypical headache and hypertension.

CASE REPORT: A 36-year-old male sought emergency care due to cervical pain after cocaine abuse. The pain was located to the right cervical side with irradiation to the homolateral temporal region. He had no previous comorbidities, except for cocaine abuse on a weekly basis. Angiotomography showed alterations compatible with recent arterial dissection of the right vertebral artery, confirmed on angioresonance. The patient received double anti-aggregation and antihypertensive drugs and was discharged. He was readmitted 5 days later due to hypertensive crisis and mild abdominal pain. Abdominal ultrasound with a Doppler of renal arteries showed signs right renal artery stenosis. Magnetic resonance angiography confirmed dissection of the same vessel. The patient underwent arteriography with stent implantation in the right renal artery. During outpatient follow-up, he progressed with gradual reduction of antihypertensive drugs.

CONCLUSIONS: There is only 1 case report correlating renal artery dissection with cocaine use and none with concomitant presentation of dissection in the vertebral and renal arterial beds. The scarcity of reports is a consequence of many problems. Therefore, young patients presenting with new-onset hypertension or abdominal pain and cocaine abuse history should raise suspicion for renal artery dissection.

Keywords: Cocaine, Dissection, Hypertension, Renovascular, Adult, Aneurysm, Dissecting, computed tomography angiography, Magnetic Resonance Angiography, Renal Artery, Self Expandable Metallic Stents, Vertebral Artery Dissection

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923