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Mycophenolate mofetil-induced pseudotumor cerebri in a boy with autoimmune lymphoproliferative disease
Turkan Patiroglu1, Alper Ozcan, Musa Karakukcu
1Department of Pediatrics, Division of Pediatric Hematology and Oncology, Faculty of Medicine, Erciyes University, 38039, Talas, Kayseri, Turkey.
Introduction:
Pseudotumor cerebri (PTC) is a syndrome characterized with increased intracranial pressure, normal cerebrospinal fluid content (CSF), and a normal brain on imaging studies. In this case report, PTC has been linked to mycophenolate mofetil (MMF) that has been used for autoimmune lymphoproliferative syndrome (ALPS).
Case Report:
A 5-year-old boy, who was using MMF for 4 months because of the ALPS, suffered from occipital headache and vomiting with no other symptom. The initial physical examination was normal expect bilateral papilledema. The patient underwent a lumbar puncture which showed elevated opening pressure (590 mmH₂O) but no laboratory abnormalities of the CSF. A diagnosis of PTC was established. MMF was stopped, and the child was started on an acetazolamide treatment for 2 weeks. His symptoms and complaints recovered after this treatment.
Discussion:
According to our knowledge, we report the first case of MMF-induced PTC in a boy with ALPS. This case illustrates that despite the rarity of MMF-induced PTC, the physicians should be aware of this possibility. Furthermore, in the setting of new-onset headaches or visual changes, early ophthalmologic examination for papilledema is recommended for early diagnosis.
Insights
This case report details the first instance of Mycophenolate Mofetil (MMF)-induced Pseudotumor Cerebri (PTC) in a boy with Autoimmune Lymphoproliferative Syndrome (ALPS). Early diagnosis and treatment led to symptom recovery.
Area of Science:
- Neurology
- Pediatrics
- Pharmacology
Background:
- Pseudotumor cerebri (PTC) is a condition of increased intracranial pressure with normal CSF and brain imaging.
- Autoimmune Lymphoproliferative Syndrome (ALPS) is an immune dysregulation disorder.
Observation:
- A 5-year-old boy with ALPS presented with headache and vomiting after 4 months of Mycophenolate Mofetil (MMF) treatment.
- Physical examination revealed bilateral papilledema; lumbar puncture showed elevated intracranial pressure (590 mmH₂O).
Findings:
- The patient was diagnosed with PTC, likely induced by MMF.
- Discontinuation of MMF and a 2-week course of acetazolamide resulted in complete symptom resolution.
Implications:
- This is the first reported case of MMF-induced PTC in a pediatric patient with ALPS.
- Clinicians should consider MMF as a potential cause of PTC, especially in patients with ALPS.
- Early ophthalmologic evaluation for papilledema is crucial for diagnosing PTC in patients with new-onset headaches or visual changes.
