Imatinib
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Retinal oedema : case report A 12-year-old girl developed retinal oedema during treatment with imatinib for chronic myeloid leukaemia (CML). The girl presented to the hospital with complaints of abdominal pain, high persistent fever and severe fatigue. Based on the laboratory findings she was diagnosed with CML. She started chemotherapy with hyper-alkalinisation, allopurinol, hydroxycarbamide [hydroxyurea] and imatinib 400mg daily [route not stated]. After 12 months, a complete cytogenetic remission was observed. Although she readmitted to the hospital with a three day history of severe headache, vomiting, pain and bilateral visual loss. She was afebrile but appeared pale. Her BP was 100/60mm Hg and heart rate was 98 beat/min. Her nervous system examination and intraocular muscle testing were normal, and there was no lymphadenopathy observed. There was an exophthalmia in both the eyes. Her pupil was sluggish to react to light. A fundoscopy was performed, which revealed bilateral stage III disc oedema and haemorrhages of the retina. Cytological evaluation of cerebrospinal fluid found negative. She did not have any other pathology for retina oedema [duration of treatment to reaction not stated]. The girl’s imatinib treatment was stopped because imatinib was considered as a suspect for retina oedema. She initiated an antioedema therapy with mannitol and dexamethasone. After a few months, she presented to the emergency department with recurrence of headache and severe vomiting along with weakness of extremities and seizures. Brain CT also performed, which showed subdural chronic haematoma and a serpenginous gyriform enhancement around the contusion in the right parietal and occipital lobes. An analysis of cerebrospinal fluid confirmed CNS extramedullary lymphoid blast infiltration. A diagnosis of extramedullary isolated CNS blast crises (CML relapse) was made. Her systemic induction chemotherapy and intrathecal therapy with methotrexate, cytarabine [arabinoside] and dexamethasone were initiated with a high dose. Imatinib therapy was replaced with dasatinib. She also received whole-brain radiation therapy. Consequently, the rapid improvement of her neurological status was noted. However, no improvement was found in her vision loss [outcome not stated]. Boudiaf H, et al. Isolated blast crisis relapse in the central nervous system of a patient treating for a chronic myelogenous leukemia. Pan African Medical Journal 36: 1-6, No. 803507882 142, Aug 2020. Available from: URL: http://doi.org/10.11604/pamj.2020.36.142.24155
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Reactions 17 Oct 2020 No. 1826
