All-trans Retinoic Acid-induced Pseudotumor Cerebri during Treatment of Acute Promyelocytic Leukemia: A Case Report

Abstract

All-trans retinoic acid (ATRA), is a first line treatment of acute promyelocytic leukemia (APML). It is a derivative of vitamin A, and a relatively safe drug, but use of ATRA can lead to side effects including some life-threatening conditions such as differentiation syndrome and pseudotumor cerebri (PC). PC is a rare disorder characterized by headache, papilledema, and/or vision loss despite normal composition of cerebrospinal fluid and normal radiological imaging of brain. It may arise as a complication of ATRA during treatment of APML. ATRA induced PC occurs predominantly in the pediatric age group. We report a rare case of ATRA-induced PC in an adult, 25 year old female undergoing consolidation treatment for APML. On discontinuation of ATRA and treatment with acetazolamide and corticosteroids symptoms improved within 5 days. ATRA was reinstituted within 2 weeks at reduced dose with prophylactic acetazolamide. Later ATRA was tolerated well by the patient and consolidation therapy was completed.