Dados do Trabalho

Título

INTRACRANIAL HYPERTENSION ASSOCIATED WITH PROLONGED USE OF FLUOROQUINOLONES: CASE REPORT

Apresentação do caso

Intracranial hypertension can be idiopathic or can be secondary to another disease. It is characterized by an increase in intracranial pressure due to obstruction of cerebral venous drainage or inability to reabsorb cerebrospinal fluid. A 6-year-old male patient was referred from the ophthalmology outpatient clinic due to blurred vision and strabismus, vomiting, occasional headaches and with excessive sleepiness. Ophthalmological evaluation identified slight proptosis of the right eyeball, 15° esotropia to the right in the primary gaze position, visual acuity of 20/25 without correction, bilateral papillary edema with intense vascular tortuosity in fundoscopy. The patient was under treatment for osteomyelitis in the left ankle with oral levofloxacin and cotrimoxazole. Laboratory tests and neuroimaging were normal. The diagnosis was made by lumbar puncture, with cerebrospinal fluid pressure of 42 cm/H2O. The patient's condition improved upon discontinuation of levofloxacin treatment for osteomyelitis. Intracranial hypertension secondary to fluoroquinolone use was considered, a complication that is well known for this group of antibiotics.

Discussão

Idiopathic intracranial hypertension is a rare disease in pediatrics but with significant risk of irreversible visual disturbances. The annual incidence is about 0.71 per 100,000 children aged 1 to 16 years, being more common in the pre-pubertal age group. In adults, it is more prevalent in obese women, which is not the case in the pediatric population. The first definition was published by Quincke in 1893, the first diagnostic criteria were described by Dandy in 1937 and updated in 1985 by Smith, where radiological imaging criteria known as modified Dandy criteria were included. In this case, the possible causal factor (levofloxacin antibiotic therapy) was discontinued, and first-line treatment with acetazolamide was initiated, resulting in complete symptom improvement and no papillary edema in the fundus of the eye.

Comentários finais

Idiopathic intracranial hypertension is a rare disease of unknown etiology, but some cases are associated with endocrine causes, systemic diseases, and medications. Therefore, the history of previous hospitalizations and medications, along with the ophthalmological examination, is of vital importance for early diagnosis and timely treatment, avoiding possible irreversible sequelae.

Palavras Chave

Intracranial Hypertension, Osteomyelitis, Quinolones

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