title: Confirmed case of levamisole-associated multifocal inflammatory leukoencephalopathy in a cocaine user.
abstract: Levamisole is a common adulterant in cocaine and has previously been associated with a variety of serious complications including multifocal inflammatory leukoencephalopathy (MIL). There have been several reports of MIL in patients taking cocaine and, though suspected, the presence of levamisole was not confirmed. We present a case of a 63-year-old woman presenting with stupor and spastic quadraparesis found to have urine positive for cocaine and levamisole. An MRI brain revealed innumerable FLAIR hyperintensities with restricted diffusion and incomplete ring-enhancement. This is the first case to confirm the presence of levamisole in a patient with MIL associated with cocaine use.
authors.affiliation: University of California, San Francisco, Department of Neurology, San Francisco, CA, USA. Electronic address: Jeffrey.vitt@ucsf.edu.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Vitt
authors.affiliation: University of California, San Francisco, Department of Neurology, San Francisco, CA, USA.
authors.forename: Ethan G
authors.initials: EG
authors.lastname: Brown
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Chow
authors.affiliation: University of California, San Francisco, Department of Neurology, San Francisco, CA, USA.
authors.forename: S Andrew
authors.initials: SA
authors.lastname: Josephson
mesh_terms: D000276:Adjuvants, Immunologic / Q000009:adverse effects* / Q000652:urine; D019970:Cocaine-Related Disorders / Q000150:complications* / Q000000981:diagnostic imaging / Q000652:urine*; D005260:Female; D006801:Humans; D007968:Leukoencephalopathy, Progressive Multifocal / Q000134:cerebrospinal fluid / Q000000981:diagnostic imaging / Q000209:etiology*; D007978:Levamisole / Q000009:adverse effects* / Q000652:urine; D008279:Magnetic Resonance Imaging; D008875:Middle Aged
chemical_list: D000276:Adjuvants, Immunologic; D007978:Levamisole