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

Hantson, Philippe;Di Fazio, Vincent;Del Mar Ramirez Fernandez, Maria;Samyn, Nele;Van Pesch, Vincent;et.al.
(2015) Journal of Medical Toxicology : official journal of the American College of Medical Toxicology — Vol. 11, n° 1, p. 124-128 (2015)

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Abstract
INTRODUCTION: Toxic leukoencephalopathy is a possible but rare complication of chronic cocaine abuse. The role of adulterants, mainly levamisole, is still debated. CASE REPORT: We describe an atypical case of fatal leukoencephalopathy mimicking Susac syndrome in a 22-year-old man who was chronically abusing cannabis and cocaine. Exposure to levamisole as adulterant to cocaine was proven by hair analysis. Despite cessation of exposure to cocaine and aggressive immunosuppressive therapy, the patient remained in a minimally conscious state until death. DISCUSSION: Susac syndrome is a rare entity, and its etiology is not yet fully elucidated. The toxic etiologies have been poorly investigated to date. Further observations are required to determine if cocaine and/or adulterants might play a significant role.
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Hantson, P., Di Fazio, V., Del Mar Ramirez Fernandez, M., Samyn, N., Duprez, T., & Van Pesch, V. (2015). Susac-Like Syndrome in a Chronic Cocaine Abuser: Could Levamisole Play a Role? Journal of Medical Toxicology : official journal of the American College of Medical Toxicology, 11(1), 124-128. https://doi.org/10.1007/s13181-014-0422-3 (Original work published 2015)