Pseudotumor cerebri in a child treated with acitretin: A rare occurrence
A 12-years-old boy with generalized pustular psoriasis attended the outpatient department of a tertiary care hospital of eastern India. Initially he was treated with methotrexate for two months in the local hospital with inadequate response and was referred to us. When he attended to us, more than 70% of the body surface area showed tenderness, erythema and were studded with pustules. After baseline investigations we put the patient on 25 mg of acitretin per day. After 10 days the dosage was increased to 35 mg/day. After one month of acitretin therapy the pustular lesions were gone and significant improvement in erythema and scaling was noticed.\nAfter one and half month, the patient complained of nausea, headache and vomiting. Antiemetic medicines were used with no result. Three days later patient complained of blurring of vision, diplopia and lacrimation. A diagnosis of PTC was suspected and the patient was sent for ophthalmological checkup, which revealed papilledema. There was no fever, neck rigidity, neurological deficit.\nHis complete blood count, ESR, liver function test, renal function test, Chest x-ray, routine urine examination were within normal limits. Lumber puncture and cerebrospinal fluid examination revealed no abnormality although measurement of exact CSF pressure could not be done in our set up. CT scan of the brain revealed no organic defect.\nBased on history, clinical features, and laboratory findings diagnosis of PTC was made. Patient was referred to consultant neurologist. Acitretin was stopped. He was put on intravenous mannitol, oral acetazolamide and systemic corticosteroid. The symptoms like nausea, diplopia, and headache waned within three days. Repeat ophthalmological examination after three days revealed disappearance of papilledema. Gradually, the dose of systemic steroid was tapered off and the patient was put on cyclosporine. With cyclosporine dose 2.5mg/kg, psoriasis was adequately controlled within two weeks.