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Levamisole-induced vasculopathy: A systematic review.

Anaïs Dartevel1, Benjamin Chaigne2, Laurence Moachon3

  • 1Service de Médecine Interne, hôpital Cochin, Centre de Référence pour les maladies systémiques autoimmunes rares d'Ile de France, DHU Authors (Autoimmune and Hormonal Diseases), Université Paris Descartes, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Service de Médecine Interne, Centre national de référence des angiœdème (CREAK), Universités des Alpes-Grenoble 1, 38041 Grenoble, France.

Seminars in Arthritis and Rheumatism
|September 1, 2018
PubMed
Summary

Levamisole-induced vasculopathy predominantly affects women, often presenting with skin lesions and positive anti-neutrophil cytoplasmic antibodies (ANCAs) or anti-phospholipid (APL) antibodies. Discontinuation of levamisole generally leads to a favorable outcome.

Keywords:
ANCALevamisoleThrombotic vasculopathyVasculitis

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Area of Science:

  • Rheumatology
  • Dermatology
  • Toxicology

Background:

  • Levamisole, an antihelminthic drug, has been associated with a distinct vasculopathy.
  • Understanding the clinical and histological characteristics of this condition is crucial for diagnosis and management.

Purpose of the Study:

  • To systematically characterize levamisole-induced vasculopathy.
  • To identify key clinical features, laboratory findings, and histological patterns.

Main Methods:

  • A systematic review of MEDLINE-indexed articles published between 1972 and 2016 was conducted.
  • Data from 111 selected articles involving 192 patients with levamisole-induced vasculopathy were analyzed.

Main Results:

  • The condition predominantly affected women (63.5%) with a median age of 44. Skin involvement (94.8%), particularly on the face and ears, was most common, with purpura being the frequent presentation.
  • Anti-neutrophil cytoplasmic antibodies (ANCAs) (93.8%) and/or anti-phospholipid (APL) antibodies (67.9%) were frequently detected. Leukopenia was observed in 50% of patients.
  • Skin biopsies revealed vasculitis (49.3%) or thrombotic vasculopathy (41.9%). While renal and pulmonary involvement occurred, the overall outcome was favorable in 86.6% of cases upon levamisole discontinuation, though relapses were noted, especially with re-exposure.

Conclusions:

  • Levamisole-induced vasculopathy is characterized by female predominance, skin manifestations, and specific antibody profiles (ANCAs, APL).
  • Histological findings include vasculitis and thrombotic lesions.
  • Despite potential systemic involvement, discontinuing levamisole typically results in a favorable prognosis.