Levamisole-induced multifocal inflammatory leukoencephalopathy: Clinical characteristics, outcome, and impact of treatment in 31 patients
Journal
Medicine
Journal Volume
85
Journal Issue
4
Pages
203-213
ISSN
0025-7974
Date Issued
2006-07
Abstract
Levamisole (LEV) has been used as an immunomodulating medication in patients with recurrent aphthous ulcers and as an adjuvant for chemotherapy. LEV, with or without 5-fluorouracil (5-FU), induces multifocal inflammatory leukoencephalopathy (MIL). We identified 31 patients with LEV-induced MIL: 7 from our institution and 24 from a MEDLINE search. Twenty-one patients (67.7%) had been treated with a combination of LEV and 5-FU, while 10 patients had been treated with LEV alone. The onset of MIL was delayed in patients who took LEV and 5-FU in combination compared with the patients treated with LEV alone (11.7 ± 3.7 vs. 4 ± 2.5 wk, p < 0.001). Colon cancer (67.7%) was the most common indication for LEV administration. Gait ataxia occurred in 20 (64.5%) patients, and dysphagia was noted in 16 (51.6%) patients. Imaging studies revealed periventricular enhancement in 17 (54.8%) patients and supratentorial lesions in 16 (51.6%) patients. Cerebrospinal fluid studies showed lymphocytic pleocytosis in 10 of 21 (47.6%) patients. Early diagnosis of MIL and discontinuation of LEV is essential, yielding good recovery in most cases. Treatment with corticosteroids and/or intravenous immunoglobulin may be needed for this serious inflammatory encephalopathy. Twenty-nine patients exhibited improved clinical status and imaging findings after initial steroid or immunoglobulin treatment. Plasmapheresis may be an alternative regimen for patients with steroid resistance. Copyright ? 2006 by Lippincott Williams & Wilkins.
SDGs
Other Subjects
betamethasone; corticosteroid; dexamethasone; fluorouracil; immunoglobulin; levamisole; methylprednisolone; prednisolone; steroid; adjuvant chemotherapy; aphasia; aphthous ulcer; article; ataxia; Babinski reflex; brain tumor; cerebrospinal fluid; clinical feature; cognitive defect; colon cancer; confusion; convalescence; diplopia; disease severity; drug indication; drug pulse therapy; drug withdrawal; dysarthria; dysphagia; early diagnosis; facial nerve paralysis; feces incontinence; gait disorder; health status; hemiparesis; human; hyperreflexia; hypersomnia; hyporeflexia; immunomodulation; information retrieval; lassitude; leukoencephalopathy; MEDLINE; monotherapy; motor dysfunction; mouth ulcer; muscle spasm; mutism; neuroimaging; neurologic disease; nuclear magnetic resonance imaging; pemphigus vulgaris; plasmapheresis; pleocytosis; priority journal; quadriplegia; seizure; side effect; statistical analysis; steroid therapy; treatment duration; treatment outcome; tremor; urine incontinence; Adult; Aged; Colonic Neoplasms; Female; Humans; Leukoencephalopathy, Progressive Multifocal; Levamisole; Male; Middle Aged; Plasmapheresis; Steroids; Treatment Outcome
Type
journal article