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Pediatric tetracycline-induced pseudotumor cerbri
A G Quinn1, S B Singer, J R Buncic
1Department of Ophthalmology, The Hospital For Sick Children, University of Toronto, Ontario, Canada.
Insights
Tetracycline antibiotics can cause pseudotumor cerebri in children, a condition previously underreported in this age group. Prompt treatment is crucial for avoiding long-term complications in pediatric patients.
Area of Science:
- Neurology
- Pediatrics
- Ophthalmology
Background:
- Tetracyclines are known to cause pseudotumor cerebri in adults.
- The occurrence of this condition in pediatric patients treated with tetracyclines is not well-characterized.
- This study presents six pediatric cases to clarify the condition, patient profile, treatment response, and sequelae.
Purpose of the Study:
- To investigate the occurrence and characteristics of pseudotumor cerebri in pediatric patients exposed to tetracyclines.
- To delineate the patient profile, treatment response, and potential long-term effects.
- To raise awareness among physicians treating children with tetracyclines about this potential complication.
Main Methods:
- Retrospective analysis of patient records at the Hospital For Sick Children, Toronto.
- Inclusion criteria: diagnosis of pseudotumor cerebri and documented tetracycline use prior to presentation.
- Study period: January 1, 1986, to March 1, 1996.
Main Results:
- Six pediatric patients (ages 12-17, 5 female) were identified, all treated for acne vulgaris.
- Symptoms included headache, nausea, and diplopia; most patients were in the upper quartile for BMI.
- All patients responded to treatment, with symptom resolution within 1 day to 4 weeks and no long-term visual sequelae.
Conclusions:
- Pseudotumor cerebri associated with tetracycline-class drugs can occur in the pediatric population.
- Prompt medical intervention can almost always prevent long-term sequelae.
- Physicians must be aware of this potential adverse effect in children prescribed tetracyclines.
Background:
Tetracyclines have long been recognized as a cause of pseudotumor cerebri in adults, but the role of tetracyclines in the pediatric age group has not been well characterized in the literature and there have been few reported cases. We present 6 cases to better delineate the problem, the patient profile, the response to treatment, and the sequelae.
Methods:
We retrospectively analyzed the records of all patients admitted with a diagnosis of pseudotumor cerebri who had documented usage of a tetracycline-class drug immediately before presentation at the Hospital For Sick Children in Toronto, Canada, from January 1, 1986, to March 1, 1996.
Results:
Six patients (5 female, 1 male) who met all inclusion and exclusion criteria were identified; their ages ranged from 12 to 17 years. All were being treated for acne vulgaris. Duration of use before diagnosis was as short as 2 weeks and as long as 10 months, with a mean of 4.4 months. Duration of symptoms ranged from 0.57 to 4 weeks. Symptoms included headache (6 of 6), nausea (5 of 6), and diplopia (4 of 6). All for whom height and weight data were known (5 of 6) were in the upper quartile for body mass index. Visual acuity was 6/6 in all but 1 eye of one patient (6/9) at diagnosis, and final visual acuity was 6/6 in all patients. All had normal color vision, where this was recorded (5 of 6). The only recorded field defect was enlargement of the blind spot (4 of 6). All patients responded to treatment, with loss of symptoms in 1 day to 4 weeks.
Conclusions:
Pseudotumor cerebri as a result of tetracycline-class drugs does occur in the pediatric population. With prompt and appropriate medical treatment, long-term sequelae can almost always be avoided. Physicians who treat patients with tetracyclines need to be aware of the potential complications in children.