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Levamisole-induced myopathy and leukocytoclastic vasculitis: a case report and literature review

Authors

  • Meng-Hsuan Tsai,

    1. Department of Medical Education and Family Medicine, National Taiwan University Hospital, Taipei, Taiwan
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  • Jen-Hung Yang,

    1. School of Medicine, Tzu Chi University, Hualien, Taiwan
    2. Department of Dermatology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
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  • Sheng-Ling Kung,

    1. Department of Neurology, Chung Shan Medical University Hospital, Taichung, Taiwan
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  • Yu-Ping Hsiao

    Corresponding author
    1. Department of Dermatology, Chung Shan Medical University Hospital, Taichung, Taiwan
    2. Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
    • Address correspondence and reprint requests to: Yu-Ping Hsiao, MD, Attending Physician, Department of Dermatology, Chung Shan Medical University Hospital, No.110, Sec.1, Chien-Kuo N.Rd. Taichung City 402, Taiwan, or email: missyuping@gmail.com.

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Abstract

Levamisole, an immunomodulator and anthelmintic medication, has been used in dermatology for years. Even though the adverse effects are usually mild and reversible, attention should be paid toward severe events such as vasculitis and neutropenia. To the best of our knowledge, this is the first case report on a patient presenting with myopathy caused by levamisole. Here, we report a 34-year-old woman with recalcitrant warts who received levamisole 100 mg daily for 5 days. Subsequently, bilateral lower limb weakness accompanied by multiple painful and non-blanchable purpura was noted. Levamisole-induced myopathy and leukocytoclastic vasculitis were diagnosed by skin histopathology, direct immunofluorescence, and electromyography. After discontinuing levamisole and giving a short course of systemic steroid, these symptoms demonstrated a resolving trend.

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