Encephalopathy induced by antihelminthic use of levamisole: report of two patients.
BACKGROUND
The antihelminthic Levamisole (LVM) is actually used as an immunomodulator in colon cancer. Its neurological toxicity is well known when used concomitantly with 5-Fluorouracil (5 FU) and, rarely when used solely at high doses. Antihelminthic imidazoles induced encephalopathy (AIIE), has been reported only in China.


METHODS
We report two Lebanese patients with AIIE, with literature review concerning the pathophysiology, clinical presentation, laboratory, imaging and prognosis of this entity.


RESULTS
AIIE supervenes after sensitization and re-exposure to the drug. It resembles the acute disseminated encephalomyelitis (ADEM) and the differentiation from multiple sclerosis is primarily based on the monophasic clinical and radiological (MRI) pattern of the disease. The treatment consists of steroids, and it has a good prognosis. The immunomodulatory role of Levamisole is evident but the pharmacokinetics remain unknown.


CONCLUSIONS
This disease entity has to be considered anytime a patient, in an endemic area for helminthiasis, develops an encephalopathy, especially after a documented exposure to imidazoles, even at low doses and particularly after re-exposure to the drug that has to be prudent.
El Kallab
Kamal
K
Department of Neurology, Notre-Dame de Secours Hospital, Byblos, Lebanon. kamal@kallab.net
El Khoury
Jihad
J
Elias
Edouard
E
Chelala
Amale
A
D000328:Adult; D000871:Anthelmintics / Q000009:adverse effects*; D003110:Colonic Neoplasms / Q000188:drug therapy; D003937:Diagnosis, Differential; D004305:Dose-Response Relationship, Drug; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007861:Lebanon; D007978:Levamisole / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D020258:Neurotoxicity Syndromes / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D011379:Prognosis; D013256:Steroids / Q000627:therapeutic use
D000871:Anthelmintics; D007155:Immunologic Factors; D013256:Steroids; D007978:Levamisole; D005472:Fluorouracil