Patient was a young adult working in finance at a major tech company found to be mute and diaphoretic.

Physical exam notable for fever, tachycardiac, hypertension, awake but not following commands, aphasic, and with hyperreflexia and muscle ridigity. CK peaked to 11,344.

MRI shows multiple ovoid to splotchy confluent lesions in the white matter with diffusion restriction. Lesions also enhanced with hyperperfusion (not shown).

Urine drug test positive for cocaine. Infectious work-up was negative. Steroids were started with good recovery.

Patient denied knowingly taking cocaine but did say weekly use of what they thought was MDMA with friends…

Final diagnosis: Levamisole-induced leukoencephalopathy. Levamisole is an antiparasite medication that is no longer used in the US but still in some other countries. It is a common cutting agent in cocaine. It’s neurotoxic effects primarily come from causing demyelination.

  • webghost0101English
    1·
    11 months ago

    You make me really glad i moved to Lemmy. I can tell that you are taking these concerns seriously and are actively trying to find the right balance. Maybe intelligent people with character and sincerity did exist on Reddit but in all my years i don’t think i ever encountered them, most people either blindly agree or start a fight because they don’t. You did research, you took time to write out additional context to help me understand the nuances and bridge the gap between both of our knowledges and worries and your taking steps to improve further because you actually care. I have nothing left to say… I really admire you for what you said and feel like i gained value simply by talking to you. Thanks for your insightful replies!