Restoration of defective cellular immunity by levamisole in a patient with immunoblastic lymphadenopathy

A 71-year-old woman presented with acutely developed symptoms of generalized lymphadenopathy, intermittent maculo-papular skin rash, pruritus, weight loss, hepato-splenomegaly, pleural exsudate and alternating breast swellings. The histopathological picture of biopsies from a lymph node and from the skin was diagnostic for immunoblastic lymphadenopathy, and the serum concentrations of IgG and IgA were increased. Delayed cutaneous hypersensitivity reactions to various antigens were totally extinguished and the number of T-lymphocytes in the peripheral blood was consistently very low. The number of both T- and B-lymphocytes further decreased during cytostatic treatment and the patient contracted numerous infections. During intermittent treatment with Levamisole the infectious episodes ceased, the cellular immune response was reestablished and the pathological hyperimmuneglobulinaemia suppressed. It is suggested that the primary immunological defect in this disease could be a failing cellular immunity, and that the hyperplasia and hyper-reactivity of the B-cell system are a secondary phenomenon.