Hội chứng giả u não khi điều trị tấn công ATRA trên bệnh nhân bạch cầu cấp tiền tủy bào: Báo cáo 1 ca lâm sàng=All-trans retinoic acid-induced pseudotumor cerebri during induction therapy for acute promyelocytic leukemia: A case report

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Tác giả: Hữu Thân Huỳnh, Ngọc Quế Anh Nguyễn, Oanh Thùy Linh Nguyễn, Quốc Tuấn Trần

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.342-348

Bộ sưu tập: Metadata

ID: 478274

Thêm vào giỏ

Báo cáo một trường hợp hội chứng giả u não (PC) hiếm gặp do axit All-trans retinoic (ATRA) ở một bệnh nhân bạch cầu cấp tiền tủy bào (APL) đang được điều trị tấn công. Ca lâm sàng: Chúng tôi báo cáo một trường hợp PC hiếm gặp do ATRA ở một bệnh nhân APL nữ 17 tuổi đang được điều trị tấn công. Các triệu chứng được cải thiện khi ngừng ATRA và điều trị bằng glucocorticoid. Trong trường hợp này, trong giai đoạn củng cố ATRA tiếp tục được sử dụng lại với liều giảm một nửa mặc dù trước đó đã được chẩn đoán mắc PC và bệnh nhân được dùng acetazolamide để điều trị dự phòng PC. Kết quả sau điều trị củng cố bao gồm bốn chu kỳ (ATRA) giảm nửa liều và arsenic trioxide (ATO) cho thấy lui bệnh về sinh học phân tử mà không có triệu chứng thần kinh tái phát. Bàn luận: ATRA được sử dụng với mục đích thúc đẩy các tế bào APL bước vào giai đoạn biệt hóa. Mặc dù ATRA là một loại thuốc dung nạp tốt nhưng một số bệnh nhân có thể gặp các biến chứng như khô da, hội chứng axit retinoic, tăng triglycerid máu, hội chứng Sweet, tăng bạch cầu và hiếm gặp là viêm cơ, PC. Cơ chế bệnh sinh của PC do ATRA gây ra ít được hiểu rõ. PC được đặc trưng bởi các triệu chứng và dấu hiệu của tăng áp lực nội sọ, bao gồm đau đầu, nhìn đôi và phù gai thị, với thành phần dịch não tủy (CSF) bình thường và các phát hiện hình ảnh não. Một số nghiên cứu trước đây báo cáo rằng PC xảy ra chủ yếu ở bệnh nhi, tuy nhiên vẫn có thể xảy ra ở người trưởng thành. Tử vong không được thấy trong bất kỳ trường hợp nào. Không có di chứng thần kinh. Cần phải có các đánh giá lâm sàng chặt chẽ để ngừng ATRA khi phát hiện nhiễm độc thần kinh và sử dụng lại ATRA vào đúng thời điểm để đạt được sự lui bệnh APL. Kết luận: ATRA là thành phần thiết yếu trong điều trị APL. Mặc dù được coi là một loại thuốc tương đối an toàn, việc sử dụng ATRA có thể dẫn đến một số tác dụng phụ như hội chứng axit retinoic và não giả (PC). PC là một rối loạn hiếm gặp đặc trưng bởi triệu chứng thần kinh và là một chẩn đoán không nên bỏ sót khi nghi ngờ trên lâm sàng.To report a rare case of All‑trans retinoic acid (ATRA)-induced pseudotumor cerebri (PC) in a patient undergoing induction treatment for acute promyelocytic leukemia (APL). Case Summary: We report a rare case of ATRA-induced PC in a 17-year-old woman undergoing induction treatment for APL. Symptoms improved with discontinuation of ATRA and treatment with glucocorticoid. In this case, ATRA with reducing half of the dose was continued despite the diagnosis of PC, and the patient was prescribed acetazolamide for prophylaxis PC. She then completed consolidation chemotherapy consisting of four cycles of (ATRA) and arsenic trioxide (ATO) without recrudescent neurologic symptoms. Discussion: ATRA is used as differentiation therapy for APL. Even though, ATRA is a welltolerated drug, some patients may develop complications like dry skin, retinoic acid syndrome, hypertriglyceridemia, sweet’s syndrome, hyperleukocytosis, and rarely myositis, PC. The pathogenesis of ATRA‑induced PC is less understood. PC is characterized by symptoms and signs of increased intracranial pressure, including headache, diplopia, and papilledema, with a normal cerebrospinal fluid (CSF) composition, and brain imaging findings. Several previous studies report, that PC is a complication of ATRA therapy occurring predominantly in pediatric patients usually within 2 weeks of initiation of treatment. Mortality was seen in none of the cases. There was no neurological sequela. This case highlights the possibility of PC while on therapy with ATRA even in the adult APML. A strong clinical judgment is necessary to stop ATRA at the onset of neurotoxicity and reinstitute ATRA at the right time to attain clinical remission. Conclusion: ATRA is an essential component in the treatment of APL. Though considered to be a relatively safe drug, use of ATRA can lead to several side effects such as retinoic acid syndrome and pseudotumor cerebri (PC). PC is a rare disorder characterized by neurologic. There was no neurological sequela.

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