Death of a steroid-dependent nephrotic syndrome patient taking levamisole: A case report

Background: Levamisole is an anthelmintic drug used in the treatment of patients with a diagnosis of steroid-dependent nephrotic syndrome. Skin rash has been reported as a drug side effect, but adverse events are really rare. Case report: The case presented in this article was a 14-year-old boy with steroiddependent nephrotic syndrome, treated with levamisole due to frequent relapse. He was admitted with rash, weakness, fatigue, fever, and weight loss. Levamisole was discontinued, and the patient’s condition improved in the following two weeks. One year later, the nephrotic syndrome relapsed, and he received prednisolone and levamisole. He was admitted to the hospital six months after re-administration of these drugs because of vasculopathy, and unfortunately, he died due to disseminated intravascular coagulation (DIC). Conclusions: Although levamisole is a suitable and cost-effective therapy for remission maintenance in steroid-dependent nephrotic syndrome, it is highly recommended to discontinue the drug without re-administration in case of reoccurring adverse effects, especially skin rash and systemic reaction, in addition to close monitoring of the patients under treatment.