Abstract
Retinoids, namely tretinoin and isotretinoin, are metabolically active derivates of vitamin A and used as therapeutic agents. Tretinoin is part of the standard therapy for patients with acute promyelocytic leukemia. Isotretinoin is applied to children with medium and high risk neuroblastoma. Further, both isomers are frequently administered to patients with acne and other skin or mucosal disorders. Isotretinoin usage in dermatology has been associated with several ocular side effects. We report on the first pediatric patient with neuroblastoma who suffered from acute transient bilateral vision loss due to optic neuritis induced by systemical administration of isotretinoin. Therefore toxic optic neuritis needs to be considered as a potential adverse effect of isotretinoin therapy and weighed carefully against therapeutic benefits. By quantum mechanical calculations it could be shown that 13-cis/trans-isomerism of tretinoin has only minor influence on the molecular shape and electrostatic potential suggesting that the biochemical interactions as well as adverse effects for tretinoin and isotretinoin might be similar.
Highlights
Retinoids, namely tretinoin and isotretinoin, are metabolically active derivates of vitamin A and used as therapeutic agents
We report on the first pediatric patient with neuroblastoma who suffered from acute transient bilateral vision loss due to optic neuritis induced by systemical administration of isotretinoin
Cis-/trans-isomerism can lead to significant changes in the three-dimensional structure of molecules which is of great importance for the interaction of a chemical compound or drug with biomolecules
Summary
Namely tretinoin and isotretinoin, are metabolically active derivates of vitamin A and used as therapeutic agents. We report on the first pediatric patient with neuroblastoma who suffered from acute transient bilateral vision loss due to optic neuritis induced by systemical administration of isotretinoin. Toxic optic neuritis needs to be considered as a potential adverse effect of isotretinoin therapy and weighed carefully against therapeutic benefits.
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