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Acne Vulgar , Antibacterianos , Pseudotumor Cerebral , Humanos , Acne Vulgar/tratamento farmacológico , Antibacterianos/efeitos adversos , Antibacterianos/administração & dosagem , Feminino , Masculino , Pseudotumor Cerebral/induzido quimicamente , Pseudotumor Cerebral/epidemiologia , Adulto , Adulto Jovem , Adolescente , Estudos de Coortes , Fatores de Risco , Tetraciclinas/efeitos adversos , Tetraciclinas/administração & dosagemAssuntos
Antineoplásicos , Leucemia Mieloide Aguda , Pseudotumor Cerebral , Humanos , Pseudotumor Cerebral/induzido quimicamente , Pseudotumor Cerebral/diagnóstico , Pseudotumor Cerebral/tratamento farmacológico , Tretinoína/efeitos adversos , Antineoplásicos/efeitos adversos , Leucemia Mieloide Aguda/diagnóstico , Leucemia Mieloide Aguda/tratamento farmacológicoRESUMO
Pseudotumor cerebri or idiopathic intracranial hypertension (IIH) secondary to psychotropic drugs is a very rare occurrence. Lithium is typically the culprit agent. Here, authors report on an interesting case of an adolescent with early-onset schizophrenia that develops a reversible IIH putatively related to olanzapine-induced weight gain. This is followed by discussion of purported pharmacodynamic mechanisms and brief review of literature. Clinicians should be cognizant to this serious complication given the propensity of the majority of atypical antipsychotics to induce significant weight gain especially in younger population.
Assuntos
Antipsicóticos , Pseudotumor Cerebral , Transtornos Psicóticos , Adolescente , Humanos , Olanzapina/efeitos adversos , Pseudotumor Cerebral/induzido quimicamente , Transtornos Psicóticos/tratamento farmacológico , Antipsicóticos/efeitos adversos , Aumento de PesoRESUMO
Tetracyclines are a class of broad-spectrum bacteriostatic antibiotics used to treat many infections, including methicillin-resistant Staphylococcus aureus (MRSA), acne, pelvic inflammatory disease, chlamydial infections, and a host of zoonotic infections. These drugs work by inhibiting protein synthesis in bacterial ribosomes, specifically by disallowing aminoacyl-tRNA molecules from binding to the ribosomal acceptor sites. While rare, tetracycline antibiotics, particularly minocycline and doxycycline, are associated with an increased risk of developing esophageal perforation and pseudotumor cerebri (PTC, or idiopathic intracranial hypertension). Since tetracyclines are a commonly prescribed class of medications, especially in adolescents for acne treatment, it is important for clinicians to appreciate significant side effects that can result in morbidity and mortality. This paper aims to consolidate and to emphasize current research on the association between tetracycline antibiotics and the development of esophageal perforation, and PTC. PTC is a neurological syndrome consisting of increased intracranial pressure, headache, and vision changes without evidence of the contributing source, such as mass lesion, infection, stroke, or malignancy. Esophageal perforation, while rare, can be the result of pill esophagitis. Pill-induced injuries occur when caustic medicinal pills dissolve in the esophagus rather than in the stomach. Most patients experience only self-limited pain (retrosternal burning discomfort, heartburn, dysphagia, or odynophagia), but hemorrhage, stricture, and perforation may occur. Tetracycline use can lead to pill esophagitis. In summary, clinicians should appreciate the potential risks of tetracycline compounds in clinical practice.
Assuntos
Acne Vulgar , Perfuração Esofágica , Esofagite , Staphylococcus aureus Resistente à Meticilina , Pseudotumor Cerebral , Adolescente , Humanos , Minociclina/efeitos adversos , Doxiciclina/efeitos adversos , Tetraciclina/efeitos adversos , Pseudotumor Cerebral/induzido quimicamente , Pseudotumor Cerebral/tratamento farmacológico , Perfuração Esofágica/induzido quimicamente , Perfuração Esofágica/tratamento farmacológico , Antibacterianos/efeitos adversos , Acne Vulgar/induzido quimicamente , Acne Vulgar/tratamento farmacológico , Esofagite/induzido quimicamente , Esofagite/tratamento farmacológico , Dor/tratamento farmacológicoRESUMO
PURPOSE: To present four female-to-male (FTM) transgender patients on testosterone therapy diagnosed with idiopathic intracranial hypertension (IIH). METHODS: The authors report 4 consecutive FTM transgender patients on exogenous testosterone diagnosed with IIH at a single institution. RESULTS: Patient 1 presented with progressive blurred vision and a central scotoma 10 weeks after starting testosterone cypionate injections for hormonal gender transition. Bilateral grade 5 papilledema was present; the patient underwent bilateral optic nerve sheath fenestration with improved vision and resolution of edema. Patient 2 presented with transient vision loss, pulsatile tinnitus, and blurred vision 13 months after starting testosterone cypionate injections. The patient had grade 4 and 3 disc edema of the right and left eyes, respectively. Patient 3 presented with headaches and pulsatile tinnitus and was on testosterone injections at an unknown dose. The examination revealed grade 1 and 2 disc edema of the right and left eyes, respectively. Patient 4 presented with decreased vision, transient visual obscurations, and daily migraines while using topical testosterone gel every other day. Color vision was reduced, and lumbar puncture revealed elevated intracranial pressure. All patients had neuroimaging findings consistent with increased intracranial pressure. CONCLUSIONS: Testosterone therapy plays an essential role in FTM hormonal transitioning and may play a role in IIH. Patients undergoing testosterone therapy for gender transition should be informed of the possibility of developing IIH while on treatment, with obesity possibly increasing this risk. Comprehensive eye examinations should be considered in these patients before initiating hormone therapy.
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Papiledema , Pseudotumor Cerebral , Zumbido , Pessoas Transgênero , Humanos , Masculino , Feminino , Pseudotumor Cerebral/induzido quimicamente , Pseudotumor Cerebral/diagnóstico , Papiledema/induzido quimicamente , Papiledema/diagnóstico , Transtornos da Visão/diagnóstico , Testosterona/efeitos adversos , EdemaAssuntos
Doença de Depósito de Glicogênio Tipo V , Hipertensão Intracraniana , Pseudotumor Cerebral , Rabdomiólise , Humanos , Acetazolamida/efeitos adversos , Pseudotumor Cerebral/induzido quimicamente , Pseudotumor Cerebral/complicações , Pseudotumor Cerebral/diagnóstico , Inibidores da Anidrase Carbônica/efeitos adversos , Rabdomiólise/induzido quimicamente , Rabdomiólise/diagnósticoRESUMO
BACKGROUND: Treatment of acute promyelocytic leukaemia has emerged as a major success in hemato-oncology. While literature from the developed world boasts of outstanding outcomes, there is a paucity of data from the developing world. This study aimed to assess complications and outcomes of acute promyelocytic leukaemia in a resource-constrained setting. METHODS: We retrospectively collected data from patients diagnosed with APL from January 2016 to December 2020. RESULTS: Sixty-four patients were treated-32 in both the Sanz high and low-risk groups. In the Sanz low-risk group, 12.5% of patients received ATRA with daunorubicin and 81.25% received ATRA with ATO. In the Sanz high-risk group, 18.8% of patients received ATRA with daunorubicin, 34.3% received ATRA with daunorubicin and ATO while 40.6% received ATRA with ATO. 56.25% of patients developed differentiation syndrome. The incidence was higher in Sanz high-risk group as compared to Sanz low-risk group. 57.4% of patients had an infection at the time of presentation. 62.5% of patients developed neutropenic fever during treatment. 17.2% of patients developed pseudotumor cerebri. The 4-year EFS and OS were 71.25 and 73.13%, respectively. Sanz low-risk group had a better 4-year EFS and OS as compared to the Sanz high-risk group. Haemoglobin at presentation and Sanz high-risk group were associated with poorer outcomes with a hazard ratio of 0.8 and 3.1, respectively. Outcomes in high-risk patients were better with the use of ATRA + ATO + daunorubicin. CONCLUSION: In the Indian population, APL patients have a high incidence of differentiation syndrome, pseudotumor cerebri, and infections during induction. CR, EFS, and OS compared to the developed world can be achieved with optimal therapy. Low haemoglobin at presentation and Sanz high-risk group were associated with poorer outcomes. ATRA, ATO, and daunorubicin combination is the preferred protocol for treating high-risk patients.
Assuntos
Antineoplásicos , Leucemia Promielocítica Aguda , Pseudotumor Cerebral , Humanos , Leucemia Promielocítica Aguda/tratamento farmacológico , Leucemia Promielocítica Aguda/diagnóstico , Leucemia Promielocítica Aguda/patologia , Tretinoína/efeitos adversos , Estudos de Coortes , Estudos Retrospectivos , Pseudotumor Cerebral/induzido quimicamente , Pseudotumor Cerebral/tratamento farmacológico , Antineoplásicos/uso terapêutico , Daunorrubicina/efeitos adversos , Síndrome , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Resultado do TratamentoRESUMO
BACKGROUND: To determine whether the use of a tetracycline-class antibiotic is associated with an increased risk of developing pseudotumor cerebri syndrome (PTCS). METHODS: We identified patients in the University of Utah Health system who were prescribed a tetracycline-class antibiotic and determined what percentage of those individuals were subsequently diagnosed with PTCS secondary to tetracycline use. We compared this calculation to the number of patients with PTCS unrelated to tetracycline use. RESULTS: Between 2007 and 2014, a total of 960 patients in the University system between the ages of 12 and 50 were prescribed a tetracycline antibiotic. Among those, 45 were diagnosed with tetracycline-induced PTCS. We estimate the incidence of tetracycline-induced PTCS to be 63.9 per 100,000 person-years. By comparison, the incidence of idiopathic intracranial hypertension (IIH) is estimated to be less than one per 100,000 person-years (Calculated Risk Ratio = 178). CONCLUSIONS: Although a causative link between tetracycline use and pseudotumor cerebri has yet to be firmly established, our study suggests that the incidence of pseudotumor cerebri among tetracycline users is significantly higher than the incidence of IIH in the general population.
Assuntos
Pseudotumor Cerebral , Adolescente , Adulto , Antibacterianos/efeitos adversos , Criança , Humanos , Incidência , Pessoa de Meia-Idade , Pseudotumor Cerebral/induzido quimicamente , Pseudotumor Cerebral/complicações , Pseudotumor Cerebral/epidemiologia , Tetraciclina/efeitos adversos , Adulto JovemRESUMO
Pseudotumour cerebri is a manifestation of intracranial hypertension in an otherwise normal individual. We hereby report phenytoin-induced pseudotumour cerebri in a 9-year-old boy who received phenytoin as a prophylactic anticonvulsant following surgical removal of unifocal Langerhans cell histiocytosis involving the right frontal bone. The child was evaluated for headache and diplopia after starting phenytoin and on evaluation was found to have bilateral sixth nerve palsy. The only abnormality detected was an elevated cerebrospinal fluid pressure. Withdrawal of phenytoin resulted in complete resolution of symptoms. Despite meticulous literature search, we found only 1 other report of phenytoin induced pseudotumour cerebri. We report this case to highlight the need to consider this entity whenever a patient presents with new onset or persistent headache and visual symptoms soon after starting a medication since a high degree of suspicion is needed to arrive at the diagnosis and to take appropriate steps before it progresses to harmful complications such as vision loss.
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Hipertensão Intracraniana , Pseudotumor Cerebral , Criança , Cefaleia/induzido quimicamente , Humanos , Masculino , Fenitoína/efeitos adversos , Pseudotumor Cerebral/induzido quimicamente , Pseudotumor Cerebral/complicações , Pseudotumor Cerebral/diagnóstico , Transtornos da Visão/complicaçõesRESUMO
INTRODUCTION: Idiopathic intracranial hypertension (IIH) (pseudotumor cerebri) is a rare side effect of all-trans retinoic acid (ATRA). IIH cases have been observed after the concomitant use of ATRA with azole group antimicrobials such as fluconazole and voriconazole. Here, we discuss about the diagnosis and treatment process of the IIH emerging in a young acute promyelocytic leukemia (APL) case with the ATRA impact, which can be increased by posaconazole. CASE: A 19-year-old male patient was diagnosed with APL. Headache and blurred vision were developed on the 12th day of the AIDA (ATRA, 45â mg/m2/day, oral and idarubicin 12â mg/m2, on days 2, 4, 6, 8, intravenous) protocol and posaconazole proflaxis. He was diagnosed IIH along with the existing eye findings and imagings. MANAGEMENT & OUTCOME: ATRA treatment and posaconazole were interrupted. Systemic acetazolamide and dexamethasone treatment were initiated. After significant clinical response was observed, ATRA treatment was resumed without posaconazole and a similar clinical condition did not recur. DISCUSSION: The combined use of ATRA and azole group drugs increases the risk of developing IIH. Patients with APL who developed IIH during the concomitant use of ATRA and fluconazole or voriconazole have been reported. To the best of our knowledge, our case is the first APL case with a IIH who treated with ATRA-based therapy and used posaconazole. In case of development of side effects, drugs should be interrupted and this combination should be avoided if possible after appropriate approach and clinical improvement.
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Leucemia Promielocítica Aguda , Papiledema , Pseudotumor Cerebral , Adulto , Fluconazol/efeitos adversos , Humanos , Leucemia Promielocítica Aguda/complicações , Leucemia Promielocítica Aguda/tratamento farmacológico , Masculino , Papiledema/induzido quimicamente , Papiledema/complicações , Papiledema/tratamento farmacológico , Pseudotumor Cerebral/induzido quimicamente , Pseudotumor Cerebral/complicações , Pseudotumor Cerebral/tratamento farmacológico , Tretinoína/efeitos adversos , Triazóis , Voriconazol/efeitos adversos , Adulto JovemRESUMO
Rise in intracranial tension (ICT) has varied clinical presentation which can range from subtle disturbances like headache to frank neurologic impairment. An important aspect is rapidity of rise of ICT. Pseudotumor cerebri is associated with many syndromes, toxication, and drugs. Our case is a unique one given the rarity of eltroxin, which is otherwise relatively safe drug and commonly used in this part of the world, induced Pseudotumor cerebri. Our patient had dramatic response to discontinuation of levothyroxine.
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Pseudotumor Cerebral , Tiroxina , Cefaleia , Humanos , Pseudotumor Cerebral/induzido quimicamente , SíndromeRESUMO
A 13-year-old male asthmatic presented to the general paediatric clinic with papilloedema identified following a check-up with his optician due to blurred vision. His asthma was well controlled on a moderate dose of inhaled corticosteroid and there had been no recent increase or decrease in the dose. A diagnosis of benign intracranial hypertension (BIH) was made based on a raised cerebrospinal fluid opening pressure, papilloedema, a normal neurological examination and normal neuroimaging. The only associated risk factor was his inhaled corticosteroids. He was commenced on acetazolamide and the inhaled corticosteroid dose was reduced, resulting in resolution of his papilloedema. This case serves to highlight that steroid side effects including BIH may occur at moderate doses of inhaled corticosteroids and that inhaled corticosteroid dose should be regularly reviewed and decreased to the lowest dose that maintains asthma control.
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Antiasmáticos , Asma , Pseudotumor Cerebral , Administração por Inalação , Adolescente , Corticosteroides/efeitos adversos , Antiasmáticos/efeitos adversos , Asma/complicações , Asma/tratamento farmacológico , Criança , Humanos , Masculino , Pseudotumor Cerebral/induzido quimicamente , Pseudotumor Cerebral/diagnóstico , Pseudotumor Cerebral/tratamento farmacológicoRESUMO
Idiopathic intracranial hypertension is a syndrome that presents with headaches and visual loss. Its pathogenesis is unknown. Treatment options include acetazolamide, therapeutic lumbar punctures or permanent CSF diversion. We present the only reported case of acute drug-induced intracranial hypertension secondary to oxytetracycline requiring urgent cerebrospinal fluid diversion. The patient's rapid visual failure progressed daily despite discontinuation of the drug and required an urgent ventriculo-peritoneal (VP) shunt insertion. Patients should be counselled about the rare potential risk of developing intracranial hypertension when commencing oxytetracycline. Rapid visual failure in IIH is a neurosurgical emergency necessitating urgent ventriculoperitoneal shunt insertion.
Assuntos
Hipertensão Intracraniana , Oxitetraciclina , Pseudotumor Cerebral , Humanos , Hipertensão Intracraniana/induzido quimicamente , Hipertensão Intracraniana/cirurgia , Pseudotumor Cerebral/induzido quimicamente , Pseudotumor Cerebral/cirurgia , Resultado do Tratamento , Derivação Ventriculoperitoneal/efeitos adversos , Transtornos da VisãoRESUMO
ABSTRACT: Doxycycline is widely used to treat early and disseminated Lyme disease. Idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri, is a rare but serious adverse reaction to this medication. This article reviews the pathophysiology, presentation, diagnosis, and treatment of a patient with disseminated Lyme disease complicated by doxycycline-induced IIH.
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Hipertensão Intracraniana , Doença de Lyme , Pseudotumor Cerebral , Doxiciclina/efeitos adversos , Humanos , Hipertensão Intracraniana/induzido quimicamente , Doença de Lyme/complicações , Doença de Lyme/diagnóstico , Doença de Lyme/tratamento farmacológico , Pseudotumor Cerebral/induzido quimicamenteRESUMO
PURPOSE: To report the correlation between recombinant growth hormone (rhGH) dosage and retinal nerve fiber layer (RNFL) thickness values measured by optical coherence tomography in a case of pseudotumor cerebri syndrome (PTCS) after rhGH. METHODS: An 11-year-old girl was receiving rhGH for panhypopituitarism. The patient developed PTCS, and her rhGH dose was adjusted using optical coherence tomography RNFL thickness measurements. The linear correlation coefficient (r) and coefficient of determination (r2) were calculated to assess the relationship between RNFL thickness and rhGH dose. RESULTS: As the rhGH dosage was increased, the RNFL thickness values also increased, especially when acetazolamide was excluded because of its confounding effect. (r = 0.64) In separate subgroup analysis, a higher acetazolamide dosage strongly correlated with reduced RNFL thickness (r = 0.77). CONCLUSION: Although PTCS is a rare complication after rhGH therapy, its detrimental effects cannot be ignored. In our case report, we used optical coherence tomography RNFL values in addition to clinical findings to carefully titrate the rhGH dosage to prevent a flare-up of PTCS. Despite the obvious need for larger studies, our case report shows the value of RNFL thickness measured by optical coherence tomography and the valuable additional data it provides to refine rhGH therapy as an adjunct noninvasive method in PTCS.
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Hormônio do Crescimento , Pseudotumor Cerebral , Tomografia de Coerência Óptica , Criança , Feminino , Hormônio do Crescimento/administração & dosagem , Hormônio do Crescimento/efeitos adversos , Humanos , Fibras Nervosas , Pseudotumor Cerebral/induzido quimicamente , Pseudotumor Cerebral/diagnóstico por imagem , Células Ganglionares da RetinaAssuntos
Pseudotumor Cerebral/etiologia , Picada de Aranha/etiologia , Cefepima/uso terapêutico , Criança , Doxiciclina/efeitos adversos , Doxiciclina/uso terapêutico , Feminino , Humanos , Pseudotumor Cerebral/induzido quimicamente , Picada de Aranha/tratamento farmacológico , Venenos de Aranha/intoxicaçãoRESUMO
Objective: To investigate the incidence of pseudotumor cerebri syndrome (PTCS) in children treated with growth hormone (GH) in a paediatric hospital and to identify risk factors for this complication. Methods: Prospective pilot study of paediatric patients treated with recombinant human GH, prescribed by the Paediatric Endocrinology Department, between February 2013 and September 2017. In all these patients, a fundus examination was performed before starting treatment and 3-4 months later. Results: Two hundred and eighty-nine patients were included, of whom 244 (84.4%) had GH deficiency, 36 (12.5%) had short stature associated with small for gestational age, six (2.1%) had a mutation in the SHOX gene and three (1.0%) had Prader-Willi syndrome. Five (1.7%) developed papilledema, all were asymptomatic and had GH deficiency due to craniopharyngioma (n=1), polymalformative syndrome associated with hypothalamic-pituitary axis anomalies (n=2), a non-specified genetic disease with hippocampal inversion (n=1) and one with normal magnetic resonance imaging who had developed a primary PTCS years before. Conclusion: GH treatment is a cause of PTCS. In our series, at risk patients had GH deficiency and hypothalamic-pituitary anatomic anomalies or genetic or chromosomal diseases. Fundus examination should be systematically screened in all patients in this at-risk group, irrespective of the presence or not of symptoms.
Assuntos
Terapia de Reposição Hormonal/efeitos adversos , Hormônio do Crescimento Humano/efeitos adversos , Hormônio do Crescimento Humano/deficiência , Papiledema/induzido quimicamente , Pseudotumor Cerebral/induzido quimicamente , Adolescente , Criança , Pré-Escolar , Feminino , Hormônio do Crescimento Humano/administração & dosagem , Humanos , Lactente , Masculino , Papiledema/diagnóstico , Projetos Piloto , Estudos Prospectivos , Pseudotumor Cerebral/diagnóstico , Proteínas Recombinantes , Fatores de RiscoRESUMO
BACKGROUND AND PURPOSE: There is a lack of comparative safety data on the risk of pseudotumor cerebri syndrome (PTCS) associated with different hormonal contraceptives. We sought to quantify the risk of PTCS associated with eight different types of hormonal contraceptives compared with oral levonorgestrel. METHODS: We conducted a retrospective cohort study, with a case-control analysis of 4 871 504 women aged 15-45 years in the period 2008-2015, using IQVIA Ambulatory Electronic Medical Records data in the USA. Patients who used nine different contraceptive agents including intrauterine levonorgestrel, medroxyprogesterone injection, etonogestrel/ethinyl estradiol vaginal ring and combination oral contraceptives (COCs) that contained ethinyl estradiol and the progestins levonorgestrel, norgestimate, desogestrel, norethindrone and drospirenone, were included. Diagnosis of PTCS was defined using the first International Classification of Diseases, 9th or 10th revision, code for intracranial hypertension in patients who had also received an imaging code in the 30 days prior to the index date. RESULTS: A total of 3323 PTCS cases and 13 292 matched controls were identified. No increase in risk was found when analysing intrauterine levonorgestrel or COCs containing desogestrel, norethindrone, drospirenone, norgestimate or norgestrel versus COC levonorgestrel. The adjusted incidence rate ratio for etonogestrel/etonogestrel/ethinyl estradiol vaginal ring and medroxyprogesterone suspension compared with levonorgestrel COC was 4.45 [95% confidence interval (CI) 1.98-9.96] and 2.20 (95% CI 1.33-3.64), respectively. CONCLUSIONS: This study found an elevated risk for PTCS among users of etonogestrel vaginal ring and medroxyprogesterone suspension when compared with oral levonorgestrel. Future studies are needed to confirm these findings.