ABSTRACT
The antihelminthic Levamisole [LVM] is actually used as an immunomodulator in colon cancer. Its neurological toxicity is well known when used concomitantly with 5-Fluorouracil [5 FU] and, rarely when used solely at high doses. Antihelminthic imidazoles induced encephalopathy [AIIE], has been reported only in China. methods: We report two Lebanese patients with AIIE, with literature review concerning the pathophysiology, clinical presentation, laboratory, imaging and prognosis of this entity. AIIE supervenes after sensitization and re-exposure to the drug. It resembles the acute disseminated encephalomyelitis [ADEM] and the differentiation from multiple sclerosis is primarily based on the monophasic clinical and radiological [MRI] pattern of the disease. The treatment consists of steroids, and it has a good prognosis. The immunomodulatory role of Levamisole is evident but the pharmacokinetics remain unknown. This disease entity has to be considered anytime a patient, in an endemic area for helminthiasis, develops an encephalopathy, especially after a documented exposure to imidazoles, even at low doses and particularly after re-exposure to the drug that has to be prudent