Toxic Optic Neuritis due to Isotretinoin in a Child with Neuroblastoma: A Case Report

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.

Evaluation of solvent effect on the effective interactions of Isotretinoin and Tretinoin: Isomeric forms of vitamin A

“…Typically, this vitamin exists as Retinal, Retinol, and Retinoic acidin many cosmetics and skincare products, serving to prevent collagen loss and ageing-related tissue damage. The biochemical structure of Vitamin A consists of a cyclic group with a linear chain that terminates with a non-polar/polar group [ [1] , [2] , [3] , [4] , [5] , [6] , [7] ]. Isotretinoin and Tretinoin are geometric isomers of Vitamin A that are applied in dermatology to treat acne and skin disorders.…”