Cocaine-Induced Leukoencephalopathy: A Case Report

Cocaine-induced leukoencephalopathy is a rare neurological condition usually associated with substances used to adulterate cocaine. A common adulterant of cocaine includes levamisole, an anti-helminthic agent, causing pathologies including vasculitis, agranulocytosis, and, in rare cases, leukoencephalopathy when ingested. Here, the authors present a comprehensive analysis of a cocaine-induced leukoencephalopathy case with the likely presence of levamisole. The patient, a 31-year-old male with an unknown past medical history, presented to the emergency department with seizure-like activity, stiffness, and posturing. Signal abnormalities found in imaging can be seen in the setting of acute cocaine-induced leukoencephalopathy and other metabolic etiologies. The patient was admitted to the neurocritical care unit for management of toxic leukoencephalopathy, acute respiratory failure with hypoxia, non-traumatic rhabdomyolysis, aspiration pneumonia, acute renal failure, and hypertensive emergency. After a 12-day hospitalization, the patient improved towards baseline and continued follow-up for further management. The case study exhibits the importance of early recognition and treatment of cocaine-induced leukoencephalopathy, the possible impacts of adulterated cocaine, the clinical outcomes of induced leukoencephalopathy, and the poor clinical outcomes without prompt intervention. Also included is the argument for levamisole testing when suspected and the use of intravenous methylprednisolone in these cases versus previously described management with methylprednisolone.