title: ATRA-induced cerebral sinus thrombosis.
abstract: All-trans retinoic acid (ATRA) and Idarubicin are part of the AIDA protocol employed for the treatment of Acute promyelocytic leaukaemia (APML) and has been associated with marked improvement in the prognosis. However, it is known to worsen the haematological picture during the course of induction of therapy. Herein, we present a case of an APML patient who developed a rare documented incidence of cerebral sinus thrombosis, first noticed as an ophthalmology referral. This 22 year old lady, a known APML patient was then started on chemotherapy based on AIDA protocol but 17 days into the initiation of therapy, she began to complain of blurred vision on the right eye. Anterior segments were normal but both fundi showed papilloedema with peripapillary haemorrhages. A contrast MRI that was then ordered showed multiple filling defects in numerous venous sinuses. She was started on anticoagulant treatment and the findings resolved. Though a rare case of its side-effects, ATRA usage in APML has a multitude of presentations since its primary pathology lies in the inherent pro-coagulant potential.
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, University Malaya, Jalan Lembah Pantai, 50606, Kuala Lumpur, Malaysia, kennethrohan@yahoo.com.
authors.forename: Kenneth Rohan
authors.initials: KR
authors.lastname: Lee
authors.forename: Visvaraja
authors.initials: V
authors.lastname: Subrayan
authors.forename: Maung Maung
authors.initials: MM
authors.lastname: Win
authors.forename: Nor
authors.initials: N
authors.lastname: Fadhilah Mohamad
authors.forename: Dinesh
authors.initials: D
authors.lastname: Patel
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D020767:Intracranial Thrombosis / Q000139:chemically induced / Q000000981:diagnostic imaging; D015473:Leukemia, Promyelocytic, Acute / Q000000981:diagnostic imaging / Q000188:drug therapy*; D018810:Magnetic Resonance Angiography; D014212:Tretinoin / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000970:Antineoplastic Agents; D014212:Tretinoin
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