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 Table of Contents  
LETTER TO EDITOR
Year : 2016  |  Volume : 2  |  Issue : 2  |  Page : 111-112

Levamisole-induced drug fever


Department of Dermatology, Venereology and Leprology, R.N.T. Medical College, Udaipur, Rajasthan, India

Date of Web Publication20-Dec-2016

Correspondence Address:
Lalit Kumar Gupta
Department of Dermatology, Venereology and Leprology, R.N.T. Medical College, Udaipur - 313 001, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2455-3972.196217

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How to cite this article:
Gupta LK, Balai M, Khare AK, Singh A, Mittal A. Levamisole-induced drug fever. Indian J Drugs Dermatol 2016;2:111-2

How to cite this URL:
Gupta LK, Balai M, Khare AK, Singh A, Mittal A. Levamisole-induced drug fever. Indian J Drugs Dermatol [serial online] 2016 [cited 2024 Mar 29];2:111-2. Available from: https://www.ijdd.in/text.asp?2016/2/2/111/196217

Sir,

A 42-year-old female patient with stable vitiligo lesions on feet and flanks for the past 5 years was prescribed 150 mg tablet of levamisole to be taken on 2 consecutive days in a week. The patient developed moderate-grade, continuous fever associated with mild headache and chills, 8 h following intake of levamisole tablet. The fever was unassociated with skin rash, rhinorrhea, lacrimation, arthralgia, myalgia, sore throat, or burning micturition. She took symptomatic treatment with paracetamol and the fever subsided in 3 days. Four days later, the fever recurred in an identical pattern, 6 h after taking levamisole tablet. The patient got admitted in the medical ward and was thoroughly evaluated for the cause of fever. She was otherwise in apparently good health and not on any other medication. Patient denied of history of reaction to any drug including levamisole in the past. Physical examination revealed temperature of 102.4°F. There was no icterus, hepatosplenomegaly, or lymphadenopathy. Systemic examination was normal. All investigations including complete blood counts, routine urine and culture, liver function and renal function tests were normal. Peripheral blood smear did not reveal the presence of malarial parasite. There was no peripheral eosinophilia. Typhidot ® for IgG and IgM was negative. Serology for dengue and chikungunya was negative. Skiagram of the chest was normal. She was symptomatically treated with paracetamol. The fever subsided in 4 days. The patient denied for provocation. She was advised not to take levamisole in the future.

Drug fever is defined as fever coinciding with the administration of a drug and disappearing after discontinuation of the drug when no other cause for the fever can be ascertained after a careful physical examination and appropriate laboratory study. Drug fever is frequently a diagnosis of exclusion made in febrile patients whose fever abates within 48-72 h of discontinuing a suspected pyrogenic agent. [1] Fever as the only manifestation of a drug reaction, though infrequent, has been reported. [2],[3],[4]

There have been reports of levamisole-induced fever alone [4] as well as fever with skin rash. [5],[6] Repeated episodes of fever in association with erythema and itching of palms and soles, 4-12 hours after levamisole intake and confirmed by rechallenge has been reported in a patient of vitiligo by Gupta et al. [6] Secher et al reported similar nature of drug reaction to levamisole when used in patient of rheumatoid arthritis. [5] The occurrence of fever on two occasions 8 and 6 h after taking levamisole strongly suggests levamisole as a cause of fever in our patient. Fever was not associated with any skin rash or hematological alteration. Fever occurred in association with headache and chills on both the occasions. Chills and headache with drug fever have been reported in 53% and 16% of cases, respectively. [1] The other causes of fever were excluded during admission in the medical ward.

The mechanism of drug-induced fever is unclear. Drug fever is believed to be hypersensitive or idiosyncratic in origin and therefore is unavoidable and unpredictable. [2] Accompanying eosinophilia seen in some patients suggests an allergic basis for such reactions. [1] Our patient, however, did not have peripheral eosinophilia. Besides being used as an anti-helminthic agent, levamisole has also been used in the treatment of several dermatological conditions like skin infections, leprosy, warts, lichen planus and aphthous ulcers. [7] It has also been used as an immunomodulatory agent in rheumatoid arthritis. Clinicians should therefore be aware of this rare side effect of levamisole. The familiarity with the condition may help to avoid unwarranted and expensive diagnostic and therapeutic interventions.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Mackowiak PA, LeMaistre CF. Drug fever: A critical appraisal of conventional concepts. An analysis of 51 episodes in two Dallas hospitals and 97 episodes reported in the English literature. Ann Intern Med 1987;106:728-33.  Back to cited text no. 1
    
2.
Tierney L. Drug fever. West J Med 1978;129:321-6.  Back to cited text no. 2
    
3.
Lipsky BA, Hirschmann JV. Drug fever. JAMA 1981;245:851-4.  Back to cited text no. 3
    
4.
Gupta R, Gupta S. Fever due to levamisole. Indian J Dermatol Venereol Leprol 2003;69:237-8.  Back to cited text no. 4
[PUBMED]  Medknow Journal  
5.
Secher L, Permin H, Skov PS, Ullman S, Halberg P. Levamisole-induced hypersensitivity. Acta Derm Venereol 1978;58:372-4.  Back to cited text no. 5
    
6.
Gupta R, Gupta S. Drug rash due to levamisole. Indian J Dermatol Venereol Leprol 2005;71:428-9.  Back to cited text no. 6
[PUBMED]  Medknow Journal  
7.
Scheinfeld N, Rosenberg JD, Weinberg JM. Levamisole in dermatology: A review. Am J Clin Dermatol 2004;5:97-104.  Back to cited text no. 7
    




 

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