SHM Converge Scientific Abstract ePoster Gallery-A Lam(i)e Diagnosis: A 48-Year-Old Woman With Bizarre Behavior

Pdf Summary

A 48-year-old woman with anxiety, depression, and polysubstance abuse was admitted under involuntary commitment for bizarre behavior, including disrobing in public, illogical speech, and homicidal ideation. She had previously been labeled as having substance-induced psychosis. After three weeks of psychiatric treatment without improvement, neurology was consulted.<br /><br />Workup showed normal TSH, ANA, B12, and CRP. Toxicology was positive for cocaine and cannabis. CSF revealed an elevated IgG index, while an encephalopathy panel was negative. MRI demonstrated diffuse white matter abnormalities consistent with leukoencephalopathy. Given the combination of cocaine use and demyelinating-appearing brain lesions, she was diagnosed with levamisole-associated multifocal inflammatory encephalopathy (LAMIE), a toxic/immune-mediated condition caused by levamisole-adulterated cocaine.<br /><br />She was treated with 5 days of IV methylprednisolone, but had no meaningful improvement. Her symptoms were managed with lorazepam, divalproex, and risperidone, and at 9-month follow-up she remained largely unchanged.<br /><br />The report emphasizes that LAMIE can mimic multiple sclerosis or acute disseminated encephalomyelitis and should be considered in patients with persistent neurologic or psychiatric symptoms and cocaine exposure. Diagnosis is supported by cocaine use, CSF inflammatory findings such as elevated IgG index or oligoclonal bands, and MRI showing multiple asymmetric white matter lesions, often in periventricular regions. Early recognition and prompt steroid treatment may improve prognosis, while delayed diagnosis may lead to poor outcomes.

Asset Subtitle

John R. Stephens

Meta Tag

Author List Emily Sturkie, John R. Stephens, Kelly Stepanek

Category Clinical Vignettes

Concept Levamisole-Associated Multifocal Inflammatory Encephalopathy

Concept Cocaine Use

Concept Levamisole

Concept Cerebrospinal Fluid Pleocytosis

Concept Cerebrospinal Fluid IgG Index

Distinguished Non-Finalist

Presenter Organization University of North Carolina

Presenting Author John R. Stephens

Track Adult

Keywords

levamisole-associated multifocal inflammatory encephalopathy

LAMIE

cocaine use

white matter lesions

demyelination

psychiatric symptoms

elevated IgG index

MRI leukoencephalopathy

IV methylprednisolone

substance-induced psychosis

Levamisole-Associated Multifocal Inflammatory Encephalopathy

Cocaine Use

Levamisole

Cerebrospinal Fluid Pleocytosis

Cerebrospinal Fluid IgG Index