How common is pseudotumor cerebri after doxycycline treatment? What is the natural course of pseudo

Fråga: How common is pseudotumor cerebri after doxycycline treatment? What is the natural course of pseudotumor cerebri after tetracycline antibiotics?

A 10-year-old boy was treated for neuroborreliosis with doxycycline for ten days. The patient developed a persistent headache and was investigated again for neuroborreliosis. The treatment was changed to intravenous ceftriaxone. Further investigation for persistent headache revealed findings consistent with Pseudotumor cerebri.

Sammanfattning: Benign intracranial hypertension is a rare adverse reaction after treatment with tetracycline antibiotics. No information concerning the exact incidence could be found. The natural cause of the condition is described briefly above.

Svar: Pseudotumor cerebri is also known as benign intracranial hypertension (BIH). Drugs recognised to cause pseudotumor cerebri are amiodarone, glucocorticoids, mineralocorticoids, vitamin A, oral contraceptives and tetracyclines (1). BIH has also been reported in association with nalidixic acid, quinolones, all-trans retinoic acid, cyclosporine, lithium, phenytoin, thyroxine, growth hormone, danazol and propophol (2,3).

BIH is due to cerebral oedema and presents as headache associated with papilloedema, sometimes complicated by diplopia due to paresis of the sixth cranial nerve, visual blurring, and visual field defects. The mechanism behind BIH is unclear. It may involve salt and water retention and intracranial fluid redistribution. There is also increasing evidence that impairment of venous sinus drainage due to occult thrombosis, perhaps at microscopic level, may be important (2).

Vision is not usually affected in the early stages, but secondary optic atrophy with reduced vision can occur if papilloedema is prolonged. Patients can experience transient obscuration of vision and sixth cranial nerve palsies with diplopia.

In Swedis (the files of the Swedish Adverse Drug Reactions Advisory Committee) there are two reports of BIH for doxycyline, one of which concerns a child: a 9-year-old boy, treated for fever. In the side-effect register of WHO there are only seven reports of BIH caused by tetracyclines; one report for doxycycline and six for minocycline (4). No further information concerning the exact incidence of BIH following tetracycline treatment could be found in the literature.