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Multifocal inflammatory leukoencephalopathy associated with levamisole and 5-fluorouracil: case report
T C Chen1, D R Hinton, L Leichman
1Department of Neurological Surgery, Los Angeles County, University of Southern California Medical Center.
Neurosurgery
|December 1, 1994
Summary
Levamisole, a chemotherapy drug, can cause multifocal inflammatory leukoencephalopathy. Stopping levamisole treatment led to the resolution of brain lesions in a patient with colon carcinoma.
Area of Science:
- Neuroscience
- Oncology
- Immunology
Background:
- Levamisole and 5-fluorouracil are standard chemotherapy for Stage III colon carcinoma.
- Adverse neurological events associated with this regimen are rare but significant.
Observation:
- A case of multifocal inflammatory leukoencephalopathy (LE) in a patient receiving levamisole and 5-fluorouracil is presented.
- MRI revealed multifocal contrast-enhancing white matter lesions.
- Brain biopsy showed reactive gliosis and macrophage infiltration, not metastatic tumor.
Findings:
- Discontinuation of levamisole, while continuing 5-fluorouracil, resulted in resolution of LE lesions on MRI without neurological deficits.
- Autopsy confirmed multifocal demyelinating lesions, with infiltrating macrophages positive for Class II antigens, IL-6, and IL-1α.
- This is the first autopsy-documented case of levamisole-associated multifocal inflammatory LE.
Implications:
- Levamisole is a potential cause of inflammatory leukoencephalopathy in cancer patients.
- Early recognition and withdrawal of levamisole may prevent severe neurological sequelae.
- Understanding the immunopathology of levamisole-induced LE is crucial for managing neurotoxicity in cancer therapy.