Cytotoxic Lesions of the Corpus Callosum Associated with Influenza B and Levosulpiride-Induced Dystonia

Starkey et al. [1] proposed the term "cytotoxic lesions of the corpus callosum" (CLOCCs) to more accurately describe the pathophysiological phenomenon characterized by transient lesions in the corpus callosum.CLOCCs are secondary findings on magnetic resonance imaging (MRI) that can be observed in a variety of diseases and conditions, including infections, drug reactions, vascular diseases, malignancies, metabolic disorders, trauma, and other entities [1].In children, viral infections are the most common cause of CLOCCs, with influenza being the predominant virus [2].However, the clinical presentations of influenza-associated CLOCCs typically include symptoms of encephalopathy or encephalitis, such as seizures, altered mental status, focal neurological deficits, among others [3,4].Levosulpiride is widely used as a prokinetic drug for treating gastric motility disorders.It acts as a selective antagonist of dopamine D2 receptors and is known to induce extrapyramidal symptoms (EPS) [5].Despite this, brain MRI examinations usually appear normal in patients exhibiting movement symptoms caused by levosulpiride [5,6].To date, there have been no reported cases of CLOCCs associated with the use of levosulpiride.Here, we report a rare case of CLOCC manifesting as cervical and oromandibular dystonia, which was triggered by levosulpiride and coincided with an influenza B infection.