title: [Multifocal inflammatory leukoencephalopathy: a complication of chemotherapy by fluorouracil and levamisole].
abstract: Two female patients with an adenocarcinoma of the colon (Duke stages B and C) underwent colectomy followed by adjuvant chemotherapy combining 5 fluorouracil (5 FU) and levamisole. Secondary neurological manifestations occurred in both patients including vertigo, nausea and vomiting, dizziness with loss of balance, slow ideation, impaired memory, headache and, on one case, central origin facial paralysis. Symptoms appeared between the 11th and 34th week of treatment. The patients had received 9 to 30 g 5 FU and 2.7 to 7.6 g levamisole. CT scan and/or MRI first suggested cerebral metastases then demyelinisation. The clinical signs disappeared spontaneously in less than one month. The brain images were unchanged. The 5 FU/levamisole combination was undoubtedly responsible for the neurological manifestations. Levamisole may have potentialized the effect of 5 FU leading to demyelinisation. Whether chemotherapy should be stopped or not is debated.
authors.affiliation: Service de Neurologie, Hôpital Ténon, Paris.
authors.forename: J P
authors.initials: JP
authors.lastname: Ferroir
authors.forename: G
authors.initials: G
authors.lastname: Fenelon
authors.forename: L
authors.initials: L
authors.lastname: Beaugerie
authors.forename: D
authors.initials: D
authors.lastname: Avenin Recoing
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D001927:Brain Diseases / Q000139:chemically induced* / Q000175:diagnosis; D001932:Brain Neoplasms / Q000556:secondary; D003110:Colonic Neoplasms / Q000188:drug therapy; D003937:Diagnosis, Differential; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects*; D006801:Humans; D007978:Levamisole / Q000009:adverse effects*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D014057:Tomography, X-Ray Computed
chemical_list: D007978:Levamisole; D005472:Fluorouracil
vernacular_title: Leucoencéphalopathie multifocale inflammatoire, complication de la chimiothérapie par 5 fluorouracile et levamisole.