PSEUDOTUMOR CEREBRAL ASSOCIADO AO USO DE ÁCIDO ALL-TRANS RETINÓICO - RELATO DE CASO Article Swipe
IAS Plentz
,
BM Borges
,
FC Domingos
,
GF Colli
,
IZ Gonçalves
,
IA Siqueira
,
MB Carneiro
,
NS Castro
·
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.1016/j.htct.2023.09.506
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.1016/j.htct.2023.09.506
Objetivo: Relatar um caso de pseudotumor cerebral associado ao uso de ácido all-trans retinóico (ATRA) em uma paciente com leucemia promielocítica aguda (LPA), a partir de informações obtidas em revisão de prontuário e revisão de literatura. Relato de caso: M.A.N, feminina, 29 anos, obesidade grau III (IMC 51,1) com quadro de fraqueza, tontura e surgimento de petéquias, sem outros sangramentos há aproximadamente 2 meses. Realizado hemograma evidenciando pancitopenia, optado por realização de mielograma e imunofenotipagem onde foram detectadas 66,7% de células blásticas (CD34- HLA-DR+) com expressão de marcadores mieloides (CD13, CD15, CD33, CD117, MPO) e biologia molecular positiva para t(15;17) PML::RARA. Iniciada terapia de indução com ATRA e trióxido de arsênico (ATO) conforme protocolo institucional. Após um mês, paciente iniciou quadro de turvação visual, cefaleia, náuseas e vômitos. Foi avaliada pela oftalmologia que evidenciou papiledema. Realizada ressonância magnética do encéfalo, das órbitas e angioressonância venosa com discreta proeminência das papilas ópticas bilateralmente, tortuosidade do nervo óptico esquerdo, glândula hipofisária com discreta redução da altura e seios venosos com calibres discretamente reduzidos difusamente. Realizada punção liquórica com pressão de abertura de 24 cm H2O com análise laboratorial normal. Feita a hipótese diagnóstica de pseudotumor cerebral, optado por suspensão da quimioterapia, iniciado acetazolamida e dexametasona. Paciente evoluiu com melhora total do quadro com retorno de tratamento em dose reduzida do ATRA (25 mg/m2) dezesseis dias após sua suspensão e seguimento ambulatorial. Atualmente PML::RARA negativo em quimioterapia de consolidação. Discussão: O ATRA é um metabólito do retinol e está envolvido na regulação de vários processos biológicos. Ele promove a maturação de células de pacientes com LPA, induz remissão completa em 64-100% dos pacientes. Porém alguns efeitos adversos da medicação têm sido relatados, incluindo a hipertensão intracraniana, predominantemente em pacientes pediátricos. O mecanismo de ação do ATRA na hipertensão intracraniana ainda é desconhecido, no entanto tem sido atribuído ao aumento da sensibilidade do sistema nervoso central à tretinoína. Observou-se que o uso de acetazolamida e suspensão temporária da quimioterapia foram benéficos no tratamento do quadro neurológico. A reintrodução do ATRA deve ser considerada após os sinais e sintomas melhorarem completamente. Conclusão: A apresentação da hipertensão intracraniana secundária ao uso de ATRA em pacientes com LPA merece consideração mesmo em adultos. Os estudos mostram também reversão do quadro neurológico com suspensão da droga e associação de diurético, além da possibilidade de retornar o tratamento após melhora do quadro.
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PSEUDOTUMOR CEREBRAL ASSOCIADO AO USO DE ÁCIDO ALL-TRANS RETINÓICO - RELATO DE CASOWork title
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2023-10-01Full publication date if available
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IAS Plentz, BM Borges, FC Domingos, GF Colli, IZ Gonçalves, IA Siqueira, MB Carneiro, NS CastroList of authors in order
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| referenced_works_count | 0 |
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| abstract_inverted_index.A | 332, 347 |
| abstract_inverted_index.O | 237, 287 |
| abstract_inverted_index.a | 23, 188, 255, 280 |
| abstract_inverted_index.e | 32, 53, 73, 94, 107, 126, 142, 164, 201, 226, 244, 320, 342, 378 |
| abstract_inverted_index.o | 316, 387 |
| abstract_inverted_index.24 | 180 |
| abstract_inverted_index.29 | 41 |
| abstract_inverted_index.Os | 366 |
| abstract_inverted_index.ao | 8, 304, 353 |
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| abstract_inverted_index.em | 15, 28, 214, 232, 266, 284, 357, 364 |
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| abstract_inverted_index.os | 340 |
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| abstract_inverted_index.uma | 16 |
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| abstract_inverted_index.MPO) | 93 |
| abstract_inverted_index.caso | 3 |
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| abstract_inverted_index.têm | 276 |
| abstract_inverted_index.(ATO) | 111 |
| abstract_inverted_index.51,1) | 47 |
| abstract_inverted_index.66,7% | 78 |
| abstract_inverted_index.Após | 115 |
| abstract_inverted_index.CD15, | 90 |
| abstract_inverted_index.CD33, | 91 |
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| abstract_inverted_index.aguda | 21 |
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| abstract_inverted_index.após | 223, 339, 389 |
| abstract_inverted_index.caso: | 38 |
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| abstract_inverted_index.foram | 76, 325 |
| abstract_inverted_index.induz | 263 |
| abstract_inverted_index.mesmo | 363 |
| abstract_inverted_index.mês, | 117 |
| abstract_inverted_index.nervo | 154 |
| abstract_inverted_index.seios | 165 |
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| abstract_inverted_index.(CD13, | 89 |
| abstract_inverted_index.(CD34- | 82 |
| abstract_inverted_index.(LPA), | 22 |
| abstract_inverted_index.CD117, | 92 |
| abstract_inverted_index.M.A.N, | 39 |
| abstract_inverted_index.Porém | 270 |
| abstract_inverted_index.Relato | 36 |
| abstract_inverted_index.alguns | 271 |
| abstract_inverted_index.altura | 163 |
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| abstract_inverted_index.Relatar | 1 |
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| abstract_inverted_index.central | 311 |
| abstract_inverted_index.efeitos | 272 |
| abstract_inverted_index.entanto | 300 |
| abstract_inverted_index.estudos | 367 |
| abstract_inverted_index.evoluiu | 204 |
| abstract_inverted_index.iniciou | 119 |
| abstract_inverted_index.melhora | 206, 390 |
| abstract_inverted_index.mostram | 368 |
| abstract_inverted_index.nervoso | 310 |
| abstract_inverted_index.normal. | 186 |
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| abstract_inverted_index.papilas | 149 |
| abstract_inverted_index.promove | 254 |
| abstract_inverted_index.quadro. | 392 |
| abstract_inverted_index.retinol | 243 |
| abstract_inverted_index.retorno | 211 |
| abstract_inverted_index.sistema | 309 |
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| abstract_inverted_index.terapia | 102 |
| abstract_inverted_index.tontura | 52 |
| abstract_inverted_index.venosos | 166 |
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| abstract_inverted_index.vários | 250 |
| abstract_inverted_index.óptico | 155 |
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| abstract_inverted_index.Iniciada | 101 |
| abstract_inverted_index.Paciente | 203 |
| abstract_inverted_index.abertura | 178 |
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| abstract_inverted_index.adversos | 273 |
| abstract_inverted_index.análise | 184 |
| abstract_inverted_index.avaliada | 129 |
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| abstract_inverted_index.cerebral | 6 |
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| abstract_inverted_index.punção | 173 |
| abstract_inverted_index.reduzida | 216 |
| abstract_inverted_index.retornar | 386 |
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| abstract_inverted_index.ópticas | 150 |
| abstract_inverted_index.órbitas | 141 |
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| abstract_inverted_index.reduzidos | 170 |
| abstract_inverted_index.redução | 161 |
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| abstract_inverted_index.reversão | 370 |
| abstract_inverted_index.trióxido | 108 |
| abstract_inverted_index.vômitos. | 127 |
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| abstract_inverted_index.Discussão: | 236 |
| abstract_inverted_index.Observou-se | 314 |
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| abstract_inverted_index.temporária | 322 |
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| abstract_inverted_index.pediátricos. | 286 |
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| abstract_inverted_index.proeminência | 147 |
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| abstract_inverted_index.sensibilidade | 307 |
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| abstract_inverted_index.intracraniana, | 282 |
| abstract_inverted_index.quimioterapia, | 198 |
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| abstract_inverted_index.angioressonância | 143 |
| abstract_inverted_index.predominantemente | 283 |
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