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Rehabilitation Practice and Science

Translated Title

Levamisole引起多發性炎性腦白質病變：病例報告

Abstract

Levamisole, which is the L-isomer of tetramisole, has been used as an antihelminthic agent. Due to its immunomodulating property, it has been used to treat recurrent aphthous ulcers, pemphigus vulgaris, and malignant melanoma. It also has been used along with 5-fluorouracil to treat colon cancer. The side effects are mild and include nausea, vomiting, diarrhea and metal taste. However, existing evidence suggests that levamisole can induce multifocal inflammatory leukoencephalopathy. The course of levamisole-induced multifocal inflammatory leukoencephalopathy is monophasic and progressive. Clinical symptoms include gait ataxia, dysarthria, dysphasia, conscious disturbance and weakness of the extremities (from hemiparesis to tetraplegia). The exact mechanism is not clear. In humans, levamisole can activate T cells and macrophages, and induce the production of interferon and interleukin-2. Levamisole may induce atransient autoimmune response, resulting in demyelination of brain white matter. We report the case of a 43-year-old male, who was treated with levamisole for human papillomavirus infection. About 1 month later, he suffered from progressive dysarthria, gait ataxia, cognitive impairment and right hemiparesis. There was no evidence of antecedent infection and specific travel history. Examinations of the serum and cerebrospinal fluid showed no abnormal findings. Brain magnetic resonance image (MRI) showed multiple lesions in the bilateral paraventricular white matter, left frontal white matter, right parietal white matter and bilateral thalamus. The patient received pulse therapy with steroids, plasma exchange and rehabilitation. His cognitive impairment, dysarthria, and motor impairment improved greatly. At the6-month follow-up, he was capable of independent level walking and stair climbing. Levamisole-induced multifocal inflammatory leukoencephalopathy is a rare inflammatory disease of the central nervous system. It may lead to permanent neurological deficits if well-timed appropriate treatment is not administered. We discuss the symptoms, differential diagnosis and treatment of this disease. To recognize levamisole-induced multifocal inflammatory leukoencephalopathy, obtaining a detailed historyis most important because it is difficult to differentiate between multifocal inflammatory leukoencephalopathy, multiple sclerosis, and acute disseminated encephalomyelitis based on neuroimaging findings alone.

Language

Traditional Chinese

First Page

235

Last Page

240

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