Pseudotumor Cerebri After Allogeneic Bone Marrow Transplant Associated With Cyclosporine A Use for Graft-Versus-Host Disease Prophylaxis

Abstract

Pseudotumor cerebri (PTC) is a syndrome of increased intracranial pressure for which several risk factors have been described. We report 2 patients who developed PTC after cyclosporine A (CsA) therapy for graft-versus-host disease (GvHD) prevention after bone marrow transplant. Both patients were obese which may have also contributed to the PTC. Cessation of CsA and combinations of mycophenolate mofetil or tacrolimus and systemic steroids and/or acetazoleamide were effective in managing the symptoms, improving the ocular complications and keeping GvHD asymptomatic. These cases suggest that induction of PTC by CsA used for GvHD prophylaxis in patients undergoing bone marrow transplant is not rare. Physicians who are following patients on CsA need to be alert to the possibility of PTC. Prompt diagnosis followed by thorough evaluation and treatment are crucial for preventing visual loss and improving associated symptoms.

The use of cyclosporine in dermatology: Part II

“…115,128 Pseudotumor cerebri has been reported in several pediatric patients taking cyclosporine. [129][130][131] In particular, tetracyclines should not be used to treat cyclosporine-induced acne because this increases the possibility of developing this complication. Three young female patients in our department have developed pseudotumor cerebri as a result of this combination, one of whom required a ventriculoperitoneal shunt.…”

Pseudotumor Cerebri Associated with Cyclosporine Use in Severe Atopic Dermatitis

“…The mechanism of CyA-related PC is unknown. There is no established relationship between serum levels of CyA and PC (2,3,5,12). The symptomatology usually appears between 4 months and 7 years after starting treatment, but in our patient it began after 2.5 months (13).…”

“…Because chronic therapy with corticosteroids or their discontinuation can be associated with PC, we cannot exclude their role in this case (3,11), although the boy had been treated with prednisone for 6 months and the tapering ended 45 days before the onset of symptoms, making CyA a more likely culprit (11). His body mass index was within the normal range, so he did not have obesity as a risk factor, nor did he have female sex as a risk factor (12). Other factors, including infections, endocrine changes, head injuries, and uremia, were also absent (3).…”

Successful Switch to Tacrolimus in a Patient with Pseudotumor Cerebri Following Cyclosporine a Treatment in Renal Transplantation

“…Perhaps CsA induces a susceptible background upon exposure to antibiotics, sulphamidics, steroids, or weight gain. 2,11,15,16 Francis et al reported that the response to medical management, such as acetazolamide or repeated lumbar puncture, was satisfactory in pediatric renal transplantation. In contrast, acetazolamide can result in worsening of renal function, metabolic acidosis, and renal stones.…”