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Pseudotumor cerebri caused by all-trans-retinoic acid: a case report
1Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand.
Abstract:
Pseudotumor cerebri is a condition characterized by increased intracranial pressure with normal cerebrospinal fluid composition. It is usually associated with many medical conditions and drugs. It has been reported that all-trans-retinoic acid can induce pseudotumor cerebri. The authors report a 35-year-old patient diagnosed with acute promyelocytic leukemia who developed pseudotumor cerebri after receiving all-trans-retinoic acid. The patient was treated with 60 mg/day of all-trans-retinoic acid. Two weeks later, she had severe headache and blurred vision. The neurological examination revealed papilledema and decreased visual acuity. Other physical examinations were unremarkable. Brain CT was normal. Additionally, lumbar puncture was performed and the CSF finding was normal except for high CSF pressure. According to modified Dandy criteria, the diagnosis was pseudotumor cerebri. The patient's symptoms disappeared after all-trans-retinoic acid was discontinued. To our knowledge, this is the first case report in Thailand.
Insights
All-trans-retinoic acid can cause pseudotumor cerebri, a condition of increased intracranial pressure. This case report details a patient with acute promyelocytic leukemia who experienced this side effect, highlighting a crucial drug-induced neurological risk.
Area of Science:
- Neurology
- Oncology
- Pharmacology
Background:
- Pseudotumor cerebri (PTC) is characterized by elevated intracranial pressure (ICP) with normal cerebrospinal fluid (CSF) composition.
- PTC is associated with various medical conditions and medications.
- All-trans-retinoic acid (ATRA) has been anecdotally linked to inducing PTC.
Observation:
- A 35-year-old female patient with acute promyelocytic leukemia (APL) was treated with ATRA 60 mg/day.
- Two weeks post-initiation of ATRA, the patient presented with severe headache and blurred vision.
- Neurological examination revealed papilledema and diminished visual acuity; brain CT was normal.
Findings:
- Lumbar puncture showed elevated CSF pressure with normal CSF composition, meeting the modified Dandy criteria for PTC.
- The patient's symptoms resolved completely upon discontinuation of ATRA.
- This represents the first reported case of ATRA-induced PTC in Thailand.
Implications:
- This case underscores the potential neurotoxic effects of ATRA, specifically the induction of PTC.
- Clinicians should maintain a high index of suspicion for PTC in patients receiving ATRA, particularly those with APL.
- Early recognition and management by discontinuing ATRA can lead to symptom resolution and prevent long-term visual impairment.