Systemic Lupus Erythematosus in 6 Male Cocaine Users at Bellevue Hospital: Table 1.

To the Editor: Genetics, environment, and gender contribute to the pathogenesis of systemic lupus erythematosus (SLE). As in other autoimmune diseases, females are more often afflicted than males, with a ratio of 9:11. Sex hormones themselves have been held responsible for this imbalance, since SLE often flares during pregnancy and tends to remit after menopause2,3. The effect of cocaine on innate and acquired immunity has been extensively investigated. While cocaine modifies immune responses and is linked to an increased susceptibility to infections4, no association between cocaine use and the induction of SLE has been described. We describe 6 cases treated at the New York University Medical Center Bellevue Hospital, an institution often characterized as the “canary in the coal mine” of urban medicine5. In this tradition, we describe 6 men with SLE with chronic cocaine abuse and suggest possible mechanisms to explain an association between cocaine and SLE6. Patients’ characteristics are detailed in Table 1. Patient 1, a 25-year-old Hispanic man with a history of polysubstance abuse, including cocaine, was diagnosed with lupus nephritis that progressed to endstage renal disease … Address correspondence to Dr. T.L. Rivera, Department of Medicine, Division of Rheumatology, New York University School of Medicine, 301 East 17th Street, Room 1410, New York, NY 10003. E-mail: tania.rivera{at}nyumc.org.