Pseudotumor cerebri after allogeneic bone marrow transplant associated with cyclosporine a use for graft-versus-host disease prophylaxis.
Pseudotumor cerebri (PTC) is a syndrome of increased intracranial pressure for which several risk factors have been described. We report 2 patients who developed PTC after cyclosporine A (CsA) therapy for graft-versus-host disease (GvHD) prevention after bone marrow transplant. Both patients were obese which may have also contributed to the PTC. Cessation of CsA and combinations of mycophenolate mofetil or tacrolimus and systemic steroids and/or acetazoleamide were effective in managing the symptoms, improving the ocular complications and keeping GvHD asymptomatic. These cases suggest that induction of PTC by CsA used for GvHD prophylaxis in patients undergoing bone marrow transplant is not rare. Physicians who are following patients on CsA need to be alert to the possibility of PTC. Prompt diagnosis followed by thorough evaluation and treatment are crucial for preventing visual loss and improving associated symptoms.
Somech
Raz
R
Divisions of Immunology/Allergy, The Hospital for Sick Children and The University of Toronto, 555 University Avenue, Toronto, Ontario, Canada. rsomech@hotmail.com
Doyle
John
J
D000293:Adolescent; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D002648:Child; D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006086:Graft vs Host Disease / Q000150:complications / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D009190:Myelodysplastic Syndromes / Q000150:complications / Q000628:therapy; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000628:therapy; D011559:Pseudotumor Cerebri / Q000139:chemically induced* / Q000175:diagnosis; D014184:Transplantation, Homologous
D007166:Immunosuppressive Agents; D016572:Cyclosporine