Pseudotumour cerebri in acute promyelocytic leukemia on treatment with all-trans-retinoic acid (ATRA) - an experience from a tertiary care centre.
Acute promyelocytic leukemia (APML) is considered to be sensitive to all-trans-retinoic acid (ATRA) which acts as a differentiating agent. ATRA is considered to be a well-tolerated agent and is known to achieve complete remission in acute promyelocytic leukemia. However, a few cases on long term all-trans-retinoic acid (ATRA) use can develop pseudotumor cerebri. Out of 32 patients with APML who were treated in our Centre over a 4-year-period, we encountered 6 patients who developed ATRA-related pseudotumor cerebri while on maintenance treatment. The patients ranged from 12 to 40 years of age. 3 patients complained of unbearable headache, 2 of diplopia and 1 of gross reduction in visual acuity. CT scans and MRI did not reveal any intracranial lesions. Cerebrospinal fluid (CSF) examination was normal with CSF manometry revealing a high CSF pressure (average of 345mmH2O). Fundoscopy revealed papilledema in 5 patients and optic atrophy in 1 patient. The patients were successfully managed with decrease dose/discontinuation of ATRA, use of acetazolamide, corticosteroids and therapeutic CSF drainage.
Sheri Kashmir Institute of Medical Sciences, Department of Hematology, Srinagar, Jammu and Kashmir, India 190011. Email: bashirnusrat@ymail.com.
Manzoor
M
Ahmad Tali
Yasir
Y
Bashir
Shuaeb
S
Bhat
Fahim
F
Manzoor
Nusrat
N
Bashir
Sajad
S
Geelani
Javid
J
Rasool
Abdul
A
Waheed Mir
D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002648:Child; D005260:Female; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000188:drug therapy*; D008297:Male; D011559:Pseudotumor Cerebri / Q000139:chemically induced* / Q000453:epidemiology; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D014212:Tretinoin / Q000009:adverse effects*; D055815:Young Adult
D000970:Antineoplastic Agents; D014212:Tretinoin