Confirmed case of levamisole-associated multifocal inflammatory leukoencephalopathy in a cocaine user

Vitt, Jeffrey R.; Brown, Ethan G.; Chow, Daniel; Josephson, S. Andrew

doi:10.1016/j.jneuroim.2017.01.018

Cited by 31 publications

(32 citation statements)

References 14 publications

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“…We described a patient with cocaine abuse who presented with Balò's type acute multifocal leukoencephalopathy. [7][8][9][10][11][12][13][14][15][16][17][18][19] MRI played a central role in the diagnosis of BCS, thanks to the identification of the characteristic "onion bulb" appearance of the lesions. MRI typically shows round and enhancing lesions, characterized by abnormal signal, hypo-or isointense on T1-weighted images and hyper-isointense on T2-weighted images, representing demyelinated and myelinated areas, respectively.…”

Section: Discussionmentioning

confidence: 99%

Balò’s concentric sclerosis in a case of cocaine-levamisole abuse

Grasso

Borreggine

Castorani

et al. 2020

SAGE Open Medical Case Reports

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Baló’s concentric sclerosis is a rare variant of multiple sclerosis. It belongs to the group of primary inflammatory central nervous system demyelinating diseases having no clear etiology. Peculiar radiological findings on magnetic resonance imaging are alternating rings of demyelinated and myelinated axons resembling an “onion bulb.” We report on a case of a patient with cocaine abuse who presented with Balò’s-like acute multifocal leukoencephalopathy supported by histological and radiological findings. The abuse of cocaine and its most frequent adulterant, levamisole, may induce ischemic or hemorrhagic stroke and metabolic or multifocal inflammatory leukoencephalopathy. Only a few studies described levamisole-induced leukoencephalopathy mimicking Balò round lesions. Nevertheless, it has not yet been established the correlation between them; it might also be possible that the cocaine/levamisole addiction represents just a coincidence in some of those patients affected by Balò sclerosis disease.

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Section: Discussionmentioning

confidence: 99%

Balò’s concentric sclerosis in a case of cocaine-levamisole abuse

Grasso

Borreggine

Castorani

et al. 2020

SAGE Open Medical Case Reports

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“…Similarly, several observational reports of MIL-like syndrome after cocaine use failed to reveal the presence of levamisole [9][10][11]. In turn, recent case reports have documented the presence of levamisole in patients with MIL or related forms of the disorder with cocaine use [4,12,13]. As in a previously reported case, the patient presented a rapidly progressive leukoencephalopathy with clinical and radiological signs consistent with SS, including numerous inflammatory white matter foci with synchronous contrast-enhancement and decreased ADC value prominently involving the corpus callosum.…”

Section: Discussionmentioning

confidence: 99%

Acute Susac Syndrome in a Recent User of Adulterated Cocaine: Levamisole as a Triggering Factor?

et al. 2020

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Susac syndrome (SS) is a central nervous system vasculitis characterized by the clinical triad of encephalopathy, sensorineural hearing loss, and visual disturbance caused by branch retinal artery occlusion. It is considered as an inflammatory disorder, and an autoimmune etiology is suggested. A 29-year-old man with a history of recent cocaine abuse developed the clinical features of SS. Toxicological analysis including hair testing revealed that cocaine had been adulterated with levamisole. After an initial clinical improvement following corticosteroid therapy, the introduction of mycophenolate mofetil was justified a few weeks later by the progression (or relapse) of the retinal injury, followed by complete recovery. The presence of levamisole has been documented in patients with multifocal inflammatory leukoencephalopathy (MIL). Further investigations are needed to determine if levamisole as an adulterant of cocaine could also play a role in the development of rapidly progressive Case

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“…Several studies have highlighted the severity of leukoencephalopathy in cocaine abusers [10][11][12], and few studies found symptomatic MRI lesions in cocaine users [13][14][15][16][17][18][19][20] and amphetamine users [21,22]. Ryan et al [20] demonstrated myelin pallor, macrophage infiltration, axonal spheroid formation with relative axonal sparing and amyloid precursor protein deposition (an immunohistochemical marker of acute axonal injury), all histological features which may be consistent with inflammatory demyelination.…”

Section: Discussionmentioning

confidence: 99%

“…Clinically, the patients demonstrated altered mental status changes and ataxia, symptoms resolving after cessation of therapy and administration of high-dose corticosteroids. With regard to cocaine abuse it should be noted that it is still unclear whether the damaging effect causing demyelination is due to cocaine itself or its additive levamisole [14,15,18,24].…”

Section: Discussionmentioning

confidence: 99%

Illicit Sympathomimetic Drug Abuse in Demyelinating Diseases

Jeppesen

Jensen

Hansen

et al. 2018

ABNE

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Multiple Sclerosis (MS) is an inflammatory demyelinating disease characterized by progressive motor deficits. Behavioral problems have previously been linked to the use of illicit drugs such as cocaine and amphetamine. We present 4 patients with frequent abuse of illicit sympathomimetics who presented with symptomatic White Matter Lesions (WML). Three patients had positive Oligoclonal Bands (OCB), one patient without OCB revealed marked pleocytosis. In this case-series we present clinical and radiological features and discuss possible mechanisms underlying substance abuse in patients with demyelinating lesions. Previous case reports in illicit sympathomimetic substance abusers highlight leukoencephalopathy rather than focally demyelinating WML. We hypothesize a two hit model with drug abuse exacerbating an unknown underlying diagnosis of MS.

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Confirmed case of levamisole-associated multifocal inflammatory leukoencephalopathy in a cocaine user

Cited by 31 publications

References 14 publications

Balò’s concentric sclerosis in a case of cocaine-levamisole abuse

Balò’s concentric sclerosis in a case of cocaine-levamisole abuse

Acute Susac Syndrome in a Recent User of Adulterated Cocaine: Levamisole as a Triggering Factor?

Illicit Sympathomimetic Drug Abuse in Demyelinating Diseases

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