Response to “Multifocal inflammatory leukoencephalopathy associated with cocaine abuse: is levamisole responsible?”

Susac-Like Syndrome in a Chronic Cocaine Abuser: Could Levamisole Play a Role?

“…In the very few reports of cocaine-associated leukoencephalopathy, the presence of levamisole has been suspected but never demonstrated [1][2][3][4]. One originality of the present observation is that a significant exposure to levamisole was proven by hair testing.…”

“…Multifocal inflammatory leukoencephalopathy (MIL) is a well-described complication of monotherapy by levamisole, and the hypothesis that adulteration of cocaine by levamisole could enhance brain inflammatory lesions has been repeatedly debated [3][4][5][6]. A recent review of 203 cases of complications reported from levamisole-adulterated cocaine failed to retrieve any subject with leukoencephalopathy [9].…”

“…The possible synergistic role of adulterants is frequently debated, and among them, levamisole is an agent that has been associated with leukoencephalopathy [3][4][5][6]. Among inflammatory brain disorders, Susac syndrome is a rare disease featured by the triad of encephalopathy, branch retinal arteries occlusions, and hearing loss [7].…”