Tollens Nadine, Post Philip, Martins Dos Santos Michael, Niggemann Pascal, Warken Melanie, Wolf Joachim
Diakonissenkrankenhaus Mannheim, Steubenstraße 91-93, 68199, Mannheim, Germany.
Zentralinstitut für seelische Gesundheit Mannheim, J5, 68159, Mannheim, Germany.
Neurol Res Pract. 2022 Aug 1;4(1):38. doi: 10.1186/s42466-022-00202-y.
Levamisole is a common adulterant of cocaine and has been associated with reversible leukoencephalopathy in cocaine users. We report a case of two episodes with severe neurological symptoms and multifocal white matter lesions with brainstem and cerebellar involvement in a 29-year-old man after sporadic cocaine consumption. A urinalysis was positive for levamisole. Neurological deficits as well as MRI presentation improved after cessation of levamisole exposure and two courses of intravenous high-dose glucocorticoid therapy. Early diagnosis of levamisole-induced multifocal leukoencephalopathy and treatment with corticosteroids without delay is essential for a good recovery from neurological symptoms. Although cocaine is one of the most prevalent abused illicit drugs, cocaine- and levamisole-induced multifocal leukoencephalopathy is underdiagnosed as this disorder is not often described in the literature and anamnesis of drug abuse is not admitted by the patient. Therefore, an additional screening for cocaine and levamisole in clinical practice is useful in similar cases to support the diagnosis.
左旋咪唑是可卡因常见的掺杂物，与可卡因使用者的可逆性白质脑病有关。我们报告了一例29岁男性在偶尔吸食可卡因后出现两次严重神经症状以及累及脑干和小脑的多灶性白质病变的病例。尿液分析显示左旋咪唑呈阳性。在停止接触左旋咪唑并进行两个疗程的静脉高剂量糖皮质激素治疗后，神经功能缺损以及磁共振成像表现有所改善。早期诊断左旋咪唑诱发的多灶性白质脑病并及时使用皮质类固醇进行治疗对于神经症状的良好恢复至关重要。尽管可卡因是最普遍滥用的非法药物之一，但可卡因和左旋咪唑诱发的多灶性白质脑病却未得到充分诊断，因为该疾病在文献中并不常被描述，且患者也不承认有药物滥用史。因此，在临床实践中对可卡因和左旋咪唑进行额外筛查有助于在类似病例中辅助诊断。
