Pseudotumor cerebri secondary to intermediate-dose cytarabine HCl

OBJECTIVE: To describe a case of pseudotumor cerebri associated with the ad ministration of intermediate-dose cytarabine. CASE SUMMARY : An Ii-year-old Hispanic boy with acute myeloblastic leukemia developed symptoms of pseudotumor cerebri (headache, diplopia, photophobia , nausea, vomiting) after receiving chemotherapy including cytarabine. The patient improved after a lumbar puncture and treatment with prednisone and acetazolamide, and is now asymptomatic. DISCUSSION: Pseudotumor cerebri is a condition usually associated with obes e women of child-bearing age. Case reports in pediatric patients are unusua l. Several medications have been implicated in causing pseudotumor cerebri, including antimicrobials (tetracycline, naladixic acid), amiodarone, lithi um carbonate, vitamin A and its derivatives, growth hormone, and corticoste roids. Chemotherapy agents reported to cause pseudotumor cerebri include bu sulfan with cyclophosphamide, and the combination of vinblastine, cisplatin , and bleomycin. Most of the information on medication-induced pseudotumor cerebri is in the form of case reports. Different mechanisms for causing th is condition have been offered for individual medications. Most of these ex planations involve fluid imbalance or interference with the Na+/K+ adenosin e triphosphatase pump. Controlled studies are difficult because this condit ion is an unpredictable and rare occurrence. Cytarabine hlw frequently been associated with neurologic toxicities, but few reports of pseudotumor cere bri can be found. CONCLUSIONS: The exact cause of pseudotumor cerebri in this patient is unkn own, but cytarabine seems a likely cause. The mechanism by which cytarabine could cause this reaction is unclear.