The treatment of sarcoidosis by levamisole

Five patients with persistent or progressive pulmonary shadowing due to sarcoidosis were treated with 150 mg levamisole daily and one patient with 150 mg twice weekly. Only the latter patient completed a 12-week course without unwanted side-effects. One of the remaining five patients on full dose completed the course but all experienced symptoms (nausea, malaise, influenza-like syndrome or arthralgia and skin rash) severe enough to cause five to stop the drug. Haematology and biochemistry, however, remained normal, with the exception of transient rise in transaminases in one patient. Radiology, pulmonary function and numbers of circulating T-lymphocytes (E-rosettes) were unchanged, but three patients developed increased intensity of delayed hypersensitivity (DH) skin tests using PPD, Candida and Trichophyton antigens; two of these patients also developed increased in vitro lymphocyte stimulation by mitogen and PPD antigen and the other developed a 'serum sickness' syndrome with evidence of circulating immune complexes.