tretinoin and Papilledema

Acute promyelocytic leukemia (APML) is a medical emergency that can initially present with neuro-ophthalmologic signs. Early recognition is crucial, and immediate treatment with all-trans retinoic acid (ATRA) and arsenic trioxide (ATO) can be life-saving. The goal of this study was to describe patients who first presented to neuro-ophthalmology and were subsequently diagnosed with APML.. We retrospectively reviewed consecutive patients seen at a tertiary neuro-ophthalmology centre. Patients with an unknown diagnosis of APML at presentation who subsequently went on to receive this diagnosis were included. Clinical characteristics, neuro-ophthalmologic findings, and outcome were retrieved.. A total of 3 patients (2 women and 1 men) with a mean age of 30.7 (range 24-33) years were included in the study. Neuro-ophthalmologic diagnoses at presentation were severe hemorrhagic papilledema related to dural venous sinus thrombosis, hemorrhagic bilateral optic disc edema, and left homonymous hemianopia related to an occipital lobe hemorrhage. At diagnosis, the average hemoglobin was 83.7g/L (range 78-104), and the platelet count was 39.3 × 109/L (range 15-77). All patients were treated with ATRA and ATO. One patient developed papilledema and sixth nerve palsies related to this treatment, which resolved with acetazolamide. Clinical follow-up ranged from 6 to 12 months, and all patients were in clinical remission about systemic APML.. Neuro-ophthalmologic symptoms may be the first manifestations of APML, and a complete blood count is an essential test in patients presenting with optic disc edema, especially if hemorrhagic.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Arsenic Trioxide; Female; Humans; Leukemia, Promyelocytic, Acute; Male; Ophthalmology; Papilledema; Retrospective Studies; Treatment Outcome; Tretinoin; Young Adult

Idiopathic intracranial hypertension (IIH) (pseudotumor cerebri) is a rare side effect of all-trans retinoic acid (ATRA). IIH cases have been observed after the concomitant use of ATRA with azole group antimicrobials such as fluconazole and voriconazole. Here, we discuss about the diagnosis and treatment process of the IIH emerging in a young acute promyelocytic leukemia (APL) case with the ATRA impact, which can be increased by posaconazole.. ATRA treatment and posaconazole were interrupted. Systemic acetazolamide and dexamethasone treatment were initiated. After significant clinical response was observed, ATRA treatment was resumed without posaconazole and a similar clinical condition did not recur.. The combined use of ATRA and azole group drugs increases the risk of developing IIH. Patients with APL who developed IIH during the concomitant use of ATRA and fluconazole or voriconazole have been reported. To the best of our knowledge, our case is the first APL case with a IIH who treated with ATRA-based therapy and used posaconazole. In case of development of side effects, drugs should be interrupted and this combination should be avoided if possible after appropriate approach and clinical improvement.

Topics: Adult; Fluconazole; Humans; Leukemia, Promyelocytic, Acute; Male; Papilledema; Pseudotumor Cerebri; Tretinoin; Triazoles; Voriconazole; Young Adult

Topics: Adult; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Humans; Intracranial Pressure; Leukemia, Promyelocytic, Acute; Male; Papilledema; Pseudotumor Cerebri; Retinal Hemorrhage; Tretinoin

Topics: Acetazolamide; Adolescent; Antineoplastic Agents; Carbonic Anhydrase Inhibitors; Female; Fundus Oculi; Humans; Intracranial Hypertension; Leukemia, Promyelocytic, Acute; Male; Papilledema; Treatment Outcome; Tretinoin

Topics: Child, Preschool; Cytarabine; Female; Humans; Leukemia, Promyelocytic, Acute; Leukocyte Count; Leukocytosis; Papilledema; Remission Induction; Tretinoin

Isotretinoin (Accutane Capsules) is a synthetic vitamin A compound used for treatment of recalcitrant cystic acne. It has numerous ocular toxic side effects which include anterior segment inflammation, dry eye syndrome, contact lens intolerance, altered refraction, photosensitivity, and reduced night vision. Eye care practitioners should be aware of these potential side effects and be prepared to communicate with the prescribing physician if side effects present.

Topics: Anterior Eye Segment; Epithelium; Eye Diseases; Humans; Isotretinoin; Night Blindness; Papilledema; Photosensitivity Disorders; Refraction, Ocular; Reproduction; Retina; Tretinoin; Vitamin A