Acitretin-associated thrombotic stroke.
OBJECTIVE
To report a case of thrombotic stroke. The etiology was difficult to identify, but was finally ascribed to psoriatic treatment with acitretin.


METHODS
Treatment with acitretin was prescribed for a 52-year-old white woman for long-standing psoriasis. Thirty-four days later, she developed nausea, vomiting, vertigo, and headaches, followed by left lateropulsion, which impeded standing and lying. Both neurologic examination and magnetic nuclear imaging indicated a rectangular infarct in the vermis cerebelli and a small bulbar infarct. Time-of-flight magnetic resonance angiography confirmed the presence of a thrombus at the beginning of the left vertebral artery. After heparin-based treatment and physiotherapy, the evolution was favorable.


CONCLUSIONS
Etiology identification of the stroke included cardiogenic pathology and coagulopathy, but acitretin treatment was considered the likeliest explanation. On review of the literature, this seems to be the first case of a thrombotic event associated with acitretin.


CONCLUSIONS
Acitretin should be considered as a possible cause of thrombotic stroke; this possibility should be kept in mind when patients taking acitretin develop an unexplained thrombotic event.
Royer
Bernard
B
Pharmacovigilance and Pharmacology Department, Jean Minjoz University Hospital, Besancon, France. bernard.royer@ufc-chu.univ-fcomte.fr
Ziegler
François
F
Muret
Patrice
P
Davani
Siamak
S
Kantelip
Jean-Pierre
JP
D017255:Acitretin / Q000009:adverse effects*; D000700:Analgesics / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D000932:Antiemetics / Q000627:therapeutic use; D011431:Dextropropoxyphene / Q000627:therapeutic use; D004294:Domperidone / Q000627:therapeutic use; D005260:Female; D006261:Headache / Q000188:drug therapy; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007641:Keratolytic Agents / Q000009:adverse effects*; D008279:Magnetic Resonance Imaging; D008787:Metoclopramide / Q000627:therapeutic use; D008875:Middle Aged; D010630:Phenindione / Q000031:analogs & derivatives* / Q000627:therapeutic use; D020521:Stroke / Q000139:chemically induced* / Q000188:drug therapy; D013927:Thrombosis / Q000139:chemically induced*
D000700:Analgesics; D000925:Anticoagulants; D000932:Antiemetics; D007641:Keratolytic Agents; D004294:Domperidone; D010630:Phenindione; D006493:Heparin; C017673:fluindione; D008787:Metoclopramide; D017255:Acitretin; D011431:Dextropropoxyphene