tetracycline and Pseudotumor-Cerebri

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.

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Doxycycline; Esophageal Perforation; Esophagitis; Humans; Methicillin-Resistant Staphylococcus aureus; Minocycline; Pain; Pseudotumor Cerebri; Tetracycline

Tetracyclines and isotretinoin are widely used treatments for patients with acne. Although generally safe, the use of these agents has been associated with pseudotumor cerebri and combination therapy with these agents may increase the risk for pseudotumor cerebri. A 14-year-old boy presented with headaches and bilateral visual loss secondary to papilledema. He had been treated with tetracycline and isotretinoin for acne for three weeks prior to presentation and was subsequently diagnosed as having pseudotumor cerebri. He required long-term medical therapy and eventually underwent bilateral optic nerve sheath decompression. The literature regarding pseudotumor cerebri in association with tetracyclines and isotretinoin treatment for acne is reviewed. Dermatologists should be aware of the risk of pseudotumor cerebri in patients receiving tetracycline or isotretinoin treatment for acne and should be particularly cautious about using both agents simultaneously.

Topics: Acne Vulgaris; Adolescent; Adult; Drug Therapy, Combination; Humans; Isotretinoin; Male; Pseudotumor Cerebri; Tetracycline

Fraternal twin sisters developed idiopathic intracranial hypertension (IIH) shortly after beginning tetracycline for treatment of acne. We reviewed from the literature 19 familial cases of IIH and 37 cases of IIH associated with tetracycline usage. Among the 37 combined adult and pediatric cases, 26 of 37 had resolution of signs or symptoms of IIH within hours to days of stopping the antibiotic, and rapid recurrence with reinitiation of drug occurred in 4 of 37. We suggest that these cases may be tetracycline-induced, may be related to an underlying genetic susceptibility, and support the notion of multifactorial etiologies for IIH.

Topics: Acne Vulgaris; Adult; Child; Diseases in Twins; Female; Humans; Papilledema; Pseudotumor Cerebri; Tetracycline; Twins, Dizygotic

Topics: Anemia, Hypochromic; Back Pain; Brain Diseases; Cerebral Ventriculography; Cerebrovascular Disorders; Child; Craniocerebral Trauma; Craniotomy; Endocrine System Diseases; Female; Genital Diseases, Female; Humans; Intracranial Pressure; Nalidixic Acid; Postoperative Complications; Pseudotumor Cerebri; Seizures; Spinal Puncture; Tetracycline; Vitamin A; Wiskott-Aldrich Syndrome

Topics: Adolescent; Brain Diseases; Brain Neoplasms; Cerebrovascular Circulation; Child; Diagnosis, Differential; Electroencephalography; Endocrine System Diseases; Female; Hematologic Diseases; Humans; Infant; Male; Obesity; Papilledema; Prognosis; Pseudotumor Cerebri; Tetracycline; Vitamin A; Vitamin A Deficiency

To determine whether the use of a tetracycline-class antibiotic is associated with an increased risk of developing pseudotumor cerebri syndrome (PTCS).. 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.. 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).. 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.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Child; Humans; Incidence; Middle Aged; Pseudotumor Cerebri; Tetracycline; Young Adult

Comparisons between clinical features of tetracycline-induced pseudotumor cerebri (PTC-T) and those of idiopathic intracranial hypertension (IIH) are absent in the literature. We hypothesized that significant clinical differences between these etiologies exist and could be better understood by retrospective analysis.. Retrospective cohort study.. We reviewed patients diagnosed with pseudotumor cerebri syndrome (PTCS) at our center and identified those who developed PTC-T after treatment with a tetracycline-class antibiotic and those with IIH. Groups were compared by demographics, body mass index, ophthalmic examination, treatment, clinical course, and visual outcomes.. We identified 52 cases of PTC-T and 302 cases of IIH. Obesity rates were significantly different (43.8% for PTC-T vs 79.2% for IIH, P < .001). The mean age at diagnosis was younger for PTC-T (19.8 years vs 28.1 years for IIH, P < .001). Diplopia was more common with PTC-T (40.4% vs 20.1% for IIH, P = .001). The mean illness duration was shorter for PTC-T (18.3 weeks vs 62.9 weeks for IIH, P <.0001). Recurrence rates were significantly different (4.0% for PTC-T vs 16.5% for IIH, P <.001). The frequency of surgical intervention was similar. Vision loss was uncommon but occurred with similar frequency.. We identified significant clinical differences but also identified important similarities between the 2 groups. There appear to be nonobese patients who develop PTC-T, discontinue the antibiotic, and never develop PTCS again. There are other patients who develop PTC-T, discontinue the antibiotic, and later develop IIH. We conclude that PTC-T represents a spectrum of disease in susceptible individuals.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Body Mass Index; Child; Diagnostic Imaging; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pseudotumor Cerebri; Retrospective Studies; Tetracycline; Young Adult

Topics: Administration, Oral; Anti-Bacterial Agents; Drug Therapy, Combination; Half-Life; Humans; Isotretinoin; Pseudotumor Cerebri; Tetracycline

To demonstrate the association between tetracycline treatment and pseudotumor cerebri (PTC).. Consecutive patients from two neuro-ophthalmic referral centers, who developed PTC syndrome post-treatment with tetracycline, were enrolled and followed for a minimum of 2 years after cessation of tetracycline.. A total of 243 consecutive patients were diagnosed with PTC; 18 had concurrent history of tetracycline treatment; a third experienced a limited course of illness with no relapses; 12 had a variable course with a prolonged relapsing illness. Mean duration of tetracycline treatment prior to diagnosis was 2.73 months.. Tetracycline, and especially minocycline, is currently considered a cause or a precipitating factor for PTC. Although there is little information on the natural course of tetracycline induced PTC, the present cases demonstrate that drug withdrawal is curative only in some patients.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Female; Humans; Male; Minocycline; Prognosis; Pseudotumor Cerebri; Retrospective Studies; Risk Factors; Tetracycline; Vision Disorders

Tetracyclines have long been recognized as a cause of pseudotumor cerebri in adults, but the role of tetracyclines in the pediatric age group has not been well characterized in the literature and there have been few reported cases. We present 6 cases to better delineate the problem, the patient profile, the response to treatment, and the sequelae.. We retrospectively analyzed the records of all patients admitted with a diagnosis of pseudotumor cerebri who had documented usage of a tetracycline-class drug immediately before presentation at the Hospital For Sick Children in Toronto, Canada, from January 1, 1986, to March 1, 1996.. Six patients (5 female, 1 male) who met all inclusion and exclusion criteria were identified; their ages ranged from 12 to 17 years. All were being treated for acne vulgaris. Duration of use before diagnosis was as short as 2 weeks and as long as 10 months, with a mean of 4.4 months. Duration of symptoms ranged from 0.57 to 4 weeks. Symptoms included headache (6 of 6), nausea (5 of 6), and diplopia (4 of 6). All for whom height and weight data were known (5 of 6) were in the upper quartile for body mass index. Visual acuity was 6/6 in all but 1 eye of one patient (6/9) at diagnosis, and final visual acuity was 6/6 in all patients. All had normal color vision, where this was recorded (5 of 6). The only recorded field defect was enlargement of the blind spot (4 of 6). All patients responded to treatment, with loss of symptoms in 1 day to 4 weeks.. Pseudotumor cerebri as a result of tetracycline-class drugs does occur in the pediatric population. With prompt and appropriate medical treatment, long-term sequelae can almost always be avoided. Physicians who treat patients with tetracyclines need to be aware of the potential complications in children.

Topics: Acetazolamide; Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Child; Dexamethasone; Diuretics; Drug Therapy, Combination; Female; Follow-Up Studies; Glucocorticoids; Humans; Magnetic Resonance Imaging; Male; Pseudotumor Cerebri; Retrospective Studies; Tetracycline; Tomography, X-Ray Computed; Visual Acuity

Idiopathic intracranial hypertension (IIH, pseudotumor cerebri) was diagnosed in 4 patients who had been treated with tetracycline. The main symptom was headache, and in all there was papilledema. Symptoms and signs improved after tetracycline was discontinued and acetazolamide treatment started. When a patient receiving tetracycline develops IIH, the medication should be stopped as it may be the cause of the IIH, as appeared to be the case in our 4 patients.

Topics: Acetazolamide; Adolescent; Adult; Female; Headache; Humans; Male; Papilledema; Pseudotumor Cerebri; Tetracycline

WITH THE MORE FREQUENT USE of antibiotics as adjuncts to periodontal therapy today, it is imperative that dental clinicians be aware of adverse reactions to these drugs, regardless of their reported incidence. It is the purpose of this case report to present and describe a rare adverse reaction to tetracycline hydrochloride called pseudotumor cerebri or benign intracranial hypertension. It is manifested by an abnormal increase in intracranial pressure and papilledema in a patient with an otherwise normal neuroradiologic condition. Although severe headache appears to be the most bothersome acute symptom, the more important long-term side effect is visual loss caused by the papilledema. Treatment should be directed towards discontinuation of the drug therapy, and immediate referral to a physician for a neuro-ophthalmic evaluation.

Topics: Actinobacillus Infections; Adult; Female; Humans; Periodontal Diseases; Pseudotumor Cerebri; Tetracycline

A female adolescent on tetracycline therapy for a dermatologic condition developed pseudotumor cerebri resulting in impaired visual acuity and papilledema. The therapy of pseudotumor cerebri is discussed.

Topics: Acne Vulgaris; Adolescent; Dexamethasone; Female; Humans; Papilledema; Pseudotumor Cerebri; Tetracycline; Vision Disorders

Benign intracranial hypertension occurred in four young women taking tetracycline for acne; two were also taking vitamin A. In a fifth case a 14-year-old boy developed papilloedema after taking a short course of tetracycline for bronchitis. All symptoms disappeared soon after stopping the drugs, though in two cases the papilloedema persisted for many months. Benign intracranial hypertension should be sought in any young woman complaining of headache during treatment with tetracycline. Moreover, young women given vitamin A and tetracycline in combination for acne may be at special risk and should be kept under surveillance.

Topics: Acne Vulgaris; Adolescent; Adult; Female; Humans; Male; Papilledema; Pseudotumor Cerebri; Sex Factors; Tetracycline

Topics: Adolescent; Drug Synergism; Female; Humans; Pseudotumor Cerebri; Tetracycline; Vitamin A

Topics: Female; Humans; Middle Aged; Pseudotumor Cerebri; Tetracycline

Topics: Adolescent; Adult; Female; Humans; Male; Pseudotumor Cerebri; Tetracycline

Topics: Acne Vulgaris; Adolescent; Female; Humans; Pseudotumor Cerebri; Tetracycline

Topics: Adolescent; Brain; Brain Diseases; Brain Edema; Cerebral Hemorrhage; Child; Craniocerebral Trauma; Diagnosis, Differential; Encephalitis; Encephalocele; Humans; Hydrocephalus; Infant; Intracranial Pressure; Meningitis; Papilledema; Pseudotumor Cerebri; Spinal Puncture; Tetracycline; Tomography, X-Ray Computed; Vitamin A

Benign intracranial hypertension due to tetracycline is described in an adolescent female. Complete resolution of the condition occurred when the drug was withdrawn.

Topics: Adolescent; Female; Humans; Papilledema; Pseudotumor Cerebri; Tetracycline

Topics: Adult; Anemia, Hypochromic; Female; Hormones; Humans; Male; Nalidixic Acid; Pseudotumor Cerebri; Sex Factors; Tetracycline; Vitamin A

Topics: Acne Vulgaris; Adolescent; Brain Diseases; Female; Humans; Intracranial Pressure; Papilledema; Pseudotumor Cerebri; Remission, Spontaneous; Tetracycline

Topics: Anorexia Nervosa; Brain Diseases; Child; Diagnosis, Differential; Headache; Humans; Male; Papilledema; Pseudotumor Cerebri; Tetracycline; Time Factors; Vomiting