Immunosuppressants and sertraline
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Immunosuppressants and sertraline Intracranial hypertension: case report
A 15-year-old girl developed intracranial hypertension (IH) during immunosuppressant treatment with mycophenolate, prednisolone, sertraline and tacrolimus. The girl was diagnosed with moderately severe rod-cone retinal dystrophy at the age of 10 years. Shortly after, she developed endstage renal failure requiring urgent peritoneal dialysis. Subsequently, she was diagnosed with Senior-Loken syndrome associated with compound heterozygous mutations in the SDCCAG8 gene. After 10 months, she had undergone renal transplantation. She started receiving immunosuppresion therapy with mycophenolate, tacrolimus, prednisolone and sertraline [routes and dosages not stated] following renal transplantation. After four and a half years of renal transplantation (at the age of 15 years), she was admitted with sepsis secondary to an Escherichia coli urinary tract infection. A year before the admission, she had frequent throbbing headaches in the temple and frontal regions which were corrected with paracetamol. At the same time, she was found to have increased photophobia, reduced best-corrected visual acuity (BCVA), elevated optic nerves and papilloedema. Therefore, during the hospital admission, she underwent a lumbar puncture which showed an opening pressure of 37 cmH20 (normal range: 10-25 cmH20). It was found that, her BMI increased from 23.4 kg/m2 to 25.9 kg/m2 over a period of 3 years. Based on the symptoms and clinical investigation, idiopathic IH [duration of treatment to reaction onset not stated] was diagnosed on May 2019. Hence, the girl started receiving treatment with a low dose of acetazolamide. After 4 weeks, in June 2019, the symptoms of headache improved and reduction in photophobia was noted. Her BCVA also improved to baseline at 0.3 both eyes with a reduction in optic nerve head swelling. Therefore, the frequency of acetazolamide administration was reduced to once a day from twice daily. Tay SA, et al. Senior-Loken syndrome and intracranial hypertension. Ophthalmic Genetics 41: 354-357, No. 4, 3 Jul 2020. Available from: URL: http:// doi.org/10.1080/13816810.2020.1766086
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Reactions 29 Aug 2020 No. 1819
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