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Multifocal inflammatory leukoencephalopathy associated with levamisole therapy
D W Kimmel1, E F Wijdicks, M Rodriguez
1Department of Neurology, Mayo Clinic, Rochester, MN 55905.
Abstract:
Cerebral demyelinating disease developed in a patient during adjuvant therapy with levamisole for malignant melanoma. This patient had no evidence of previous neurologic disease. Levamisole was administered for 5 weeks (total dose, 1,500 mg). Over a period of 3 weeks, the patient became progressively confused and ataxic. MRI with gadolinium enhancement demonstrated prominent multifocal enhancing white matter lesions. CSF examination revealed an inflammatory profile. After discontinuation of treatment with levamisole and a short course of corticosteroid therapy, the patient's condition dramatically improved. MRI also indicated improvement. Observations in our patient suggest that the leukoencephalopathy that developed in previously reported patients who received 5-fluorouracil and levamisole may have been caused at least partly by levamisole.
Insights
Levamisole, used for melanoma treatment, can cause demyelinating disease. This neurological side effect, characterized by confusion and ataxia, improved after discontinuing levamisole therapy.
Area of Science:
- Neuroscience
- Oncology
- Pharmacology
Background:
- Adjuvant therapy for malignant melanoma often involves chemotherapy agents.
- Levamisole is an immunomodulatory drug sometimes used in cancer treatment protocols.
- Neurological side effects of cancer therapies require careful monitoring.
Observation:
- A patient undergoing adjuvant levamisole therapy for melanoma developed cerebral demyelinating disease.
- Symptoms included progressive confusion and ataxia over three weeks.
- Magnetic resonance imaging (MRI) revealed multifocal white matter lesions with gadolinium enhancement.
Findings:
- Cerebrospinal fluid (CSF) analysis showed an inflammatory profile.
- Discontinuation of levamisole and a course of corticosteroids led to dramatic clinical and MRI improvement.
- The findings suggest levamisole may contribute to or cause leukoencephalopathy.
Implications:
- Levamisole should be considered a potential cause of demyelinating disease in cancer patients.
- This case highlights the importance of recognizing drug-induced neurological toxicity.
- Further investigation into levamisole's neurotoxic potential is warranted.