Multifocal inflammatory leukoencephalopathy associated with levamisole and 5-fluorouracil: case report

Update item information
Publication Type Journal Article
School or College School of Medicine
Department Neurosurgery
Creator Couldwell, William T.
Other Author Chen, Thomas C.; Hinton, David R.; Leichman, Lawrence; Atkinson, Roscoe D.; Apuzzo, Michael L. J.
Title Multifocal inflammatory leukoencephalopathy associated with levamisole and 5-fluorouracil: case report
Date 1994
Description LEVAMISOLE AND 5-FLUOROURACIL have now become the standard chemotherapeutic regimen for patients with Stage 111 colon carcinoma. A case of multifocal inflammatory leukoencephalopathy secondary to levamisole alone or combination of levamisole and 5-fluorouracil is reported. Magnetic resonance imaging with gadolinium demonstrated multifocal contrast-enhancing frontal, parietal, occipital, and periventricular white matter lesions. A stereotactic biopsy revealed reactive gliosis and macrophage infiltration, without "evidence of metastatic tumor. Despite continuation of 5-fluorouracil, resolution of contrast-enhancing lesions on magnetic resonance imaging without further neurological sequelae occurred when levamisole was stopped. The patient died with evidence of systemic metastasis 6 months later. Autopsy examination of the brain revealed multifocal demyelinating lesions, with no evidence of metastatic tumor. Immunoperoxidase studies of demyelinated lesions demonstrated infiltrating macrophages strongly positive for Class II antigens, interleukin-6, and interleukin-1 a. Surrounding astrocytes were positive for granulocyte macrophage colony-stimulating factor. Small numbers of perivascular T cells were present. This patient represents the first autopsy documented case of levamisole associated multifocal inflammatory leukoencephalopathy.
Type Text
Publisher Wolters Kluwer (LWW)
Volume 35
Issue 6
First Page 1138
Last Page 1143
Subject Autopsy; Levamisole; Multifocal inflammatory leukoencephalopathy
Subject LCSH Drugs -- Side effects; Nervous system -- Diseases
Language eng
Bibliographic Citation Chen, T. C., Hinton, D. R., Leichman, L., Atkinson, R. D., Apuzzo, M. L. J., & Couldwell, W. T. (1994). Multifocal inflammatory leukoencephalopathy associated with levamisole and 5-fluorouracil: case report. Neurosurgery, 35(6), 1138-43.
Rights Management (c) Wolters Kluwer (LWW) http://lww.com
Format Medium application/pdf
Format Extent 1,193,745 bytes
Identifier ir-main,12539
ARK ark:/87278/s6b85sb8
Setname ir_uspace
Date Created 2012-06-13
Date Modified 2012-06-13
ID 703413
Reference URL https://collections.lib.utah.edu/ark:/87278/s6b85sb8
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