Pediatric recurrent intracranial hypertension secondary to All-Trans Retinoic Acid treatment in a patient with acute promyelocytic leukemia: value of retinal nerve fiber layer thickness in management
Turkish Journal of Pediatrics, cilt.68, sa.3, ss.501-514, 2026 (SCI-Expanded, Scopus, TRDizin)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 68 Sayı: 3
- Basım Tarihi: 2026
- Doi Numarası: 10.24953/turkjpediatr.2026.6693
- Dergi Adı: Turkish Journal of Pediatrics
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, EMBASE, Directory of Open Access Journals, TR DİZİN (ULAKBİM), Biomedical Reference Collection: Corporate Edition (EBSCO), Health Research Premium Collection (ProQuest)
- Sayfa Sayıları: ss.501-514
- Anahtar Kelimeler: acute promyelocytic leukemia, ATRA, intracranial hypertension, papilledema, retinal nerve fiber layer thickness
- Açık Arşiv Koleksiyonu: AVESİS Açık Erişim Koleksiyonu
- Hacettepe Üniversitesi Adresli: Evet
Özet
Background. All-trans retinoic acid (ATRA) is an essential agent in the treatment of acute promyelocytic leukemia (APL). However, careful monitoring is required due to its potential side effects, particularly intracranial hypertension (IH). Case Presentation. Here, we report a 15-year-old girl who presented with headache, blurred vision, vomiting, and was found to have left homonymous hemianopsia and an acute cerebral infarct. Etiological investigations revealed acute promyelocytic leukemia and treatment with ATRA was initiated. However, this treatment was complicated by repetitive episodes of IH, which improved with discontinuation of ATRA but recurred whenever reinitiation was attempted. Despite this side effect, the patient was able to complete the planned ATRA course under medical treatment of IH, guided by retinal nerve fiber layer (RNFL) thickness measured using optical coherence tomography (OCT). Conclusions. Changes in papilledema were detected on OCT earlier than on clinical examination. This case illustrates the reversibility of IH secondary to ATRA therapy, the feasibility of completing ATRA treatment despite the side effect of IH, the importance of medical treatment for IH in combination with appropriate dose adjustments, and the accuracy and convenience of RNFL thickness as a biomarker for treatment efficiency. Managing IH in the context of a chronic systemic disorder requires a collaborative approach, close follow-up, and individualized management.