Severe thrombocytopenia from acute levamisole toxicity in a Nigerian child

Levamisole-induced thrombocytopenia and vasculitis are rare entities in children. Here, we report a 5-year-old male who presented with complaints of purpuric rashes and nasal and gum bleeding for 24 h following intake of single high-dose levamisole for presumptive treatment of helminthiasis. No preceding symptoms of viral infection or bleeding into closed spaces were noted. He was clinically stable except for maculopapular and patchy purpuric rashes on the face, neck, and trunk. No hepatosplenomegaly or lymphadenopathy was observed. Full blood count and blood film showed severe thrombocytopenia of 6.00 × 109/L and platelets left shift with dysplastic neutrophils. He was commenced on prednisolone and transfused with fresh whole blood. The patient improved remarkably and showed reversal of hematological parameters within 48 h. Further, full blood count examination showed reactive thrombocytosis. Levamisole induces reversible thrombocytopenia by immune-mediated cytotoxic destruction of the platelets and white blood cells.