左旋咪唑致脱髓鞘脑病

Demyelination encephalitis caused by levamisole

1例53岁上呼吸道感染男性患者为增加免疫力服用左旋咪唑50 mg,1次/d治疗,连续服药3 d。15 d后,患者出现头晕、嗜睡症状。之后,症状逐渐加重,出现动作迟缓、言语不清、行走困难、意识模糊及抽搐。1个月后患者陷入深度昏迷。动态脑电图检查示弥漫性δ波活动。核磁共振示双侧基底节区及额顶叶脑白质内见多发点状、斑片状长T2长T1信号灶,FLAIR序列和DW I呈高信号。诊断:左旋咪唑所致脱髓鞘脑病。给予糖皮质激素及对症治疗,1个月后患者好转,但仍有步态不稳。

A 53-year-old man with upper respiratory infection received levamisole 50 mg once daily for 3 days for enhancing immunity. Fifteen days later, the patient developed dizziness and somnolence. Subsequently, his condition deteriorated and he had bradykinesia, slurred speech, difficulty walking, confusion, and convulsion; one month later, he went into a deep coma. His aEEG showed diffuse δ wave activities. NMR revealed the punctuate and patchy foei of T1 and T2 signal prolongations in the basal ganglia area and frontal and parietal lobes. Hypersignals were on FLAIR sequences and DWI . Levamisole-induced demyelinating encepbalopathy was diagnosed. Corticosteroids and symptomatic treatment were given. After one month, the patient improved, but he still had unstable walking.