Minocycline-induced Diplopia in Philadelphia Chromosome-positive Acute Lymphoblastic Leukemia (Ph+ALL): A Case Report

Zeeshan Ahmed Khattak *

Shifa International Hospital, Islamabad, Pakistan.

Muhammad Ayaz Mir

Shifa International Hospital, Islamabad, Pakistan.

Danyal Ahmad Ghani

Shifa International Hospital, Islamabad, Pakistan.

Nishad Gul

Riphah International University, Islamabad, Pakistan.

*Author to whom correspondence should be addressed.


Abstract

Background: Minocycline is frequently utilized for multiple drug-resistant (MDR) and extensively drug-resistant bacteria (XDR), but is associated with many side effects. Idiopathic intracranial hypertension is one such effect resulting from the precipitation of raised intracranial pressure (ICP), manifesting as headaches, diplopia or even vision loss. The aim of this report is to present a case of Philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ ALL) with XDR Escherichia coli (E. coli) treated with minocycline. This resulted in elevated ICP with associated symptoms which were initially thought to be due to central nervous system (CNS) involvement by primary disease.

Case Presentation: A 14-year-old girl was given minocycline therapy for XDR E. coli, which was cultured from her blood, for two weeks. Patient develop complaints of nausea, vomiting, headache, blurring and doubling of vision one week into therapy. Lumbar puncture and brain imaging were performed to rule out CNS involvement with Ph+ ALL, which were reported as negative for malignancy. Minocycline was suspected to have precipitated the event and was discontinued. The patient recovered within one week after cessation of therapy. 

Conclusion: Minocycline can be associated with symptomatic elevation of intracranial pressure, which can easily be mistaken for CNS involvement in patients with neoplastic disease, and can reverse upon discontinuation of the drug.

Keywords: Diplopia, Acute Lymphoblastic Leukemia (ALL), extensively drug-resistant bacteria, idiopathic intracranial hypertension, minocycline


How to Cite

Khattak , Z. A., Mir, M. A., Ghani, D. A., & Gul , N. (2023). Minocycline-induced Diplopia in Philadelphia Chromosome-positive Acute Lymphoblastic Leukemia (Ph+ALL): A Case Report. International Journal of Research and Reports in Hematology, 6(2), 144–148. Retrieved from https://journalijr2h.com/index.php/IJR2H/article/view/116

Downloads

Download data is not yet available.

References

Kakaje A, Alhalabi MM, Ghareeb A, Karam B, Mansour B, Zahra B, Hamdan O. Rates and trends of childhood acute lymphoblastic leukaemia: an epidemiology study. Sci Rep. 2020;10(1):6756. DOI: 10.1038/s41598-020-63528-0

Lenk L, Alsadeq A, Schewe DM. Involvement of the central nervous system in acute lymphoblastic leukemia: opinions on molecular mechanisms and clinical implications based on recent data. Cancer Metastasis Rev. 2020 Mar;39(1):173-187. DOI: 10.1007/s10555-020-09848-z

Deak D, Gorcea-Andronic N, Sas V, Teodorescu P, Constantinescu C, Iluta S, et al. A narrative review of central nervous system involvement in acute leukemias. Ann Transl Med. 2021;9(1):68. DOI: 10.21037/atm-20-3140

Gaur S, Torabi AR, Corral J. Isolated central nervous system relapse in two patients with BCR-ABL-positive acute leukemia while receiving a next-generation tyrosine kinase inhibitor. In Vivo. 2014;28(6):1149-53.

Perdikouri EIA, Arvaniti K, Lathyris D, Apostolidou Kiouti F, Siskou E, et al. Infections due to multidrug-resistant bacteria in oncological patients: Insights from a five-year epidemiological and clinical analysis. Microorganisms. 2019; 7(9):277. DOI: 10.3390/microorganisms7090277

Paramo R, Leishangthem L. Optic atrophy secondary to minocycline-induced idiopathic intracranial hypertension. BMJ Case Rep. 2023 Mar 28;16(3):e252731. DOI: 10.1136/bcr-2022-252731

Arezoo Asadi, Milad Abdi, Ebrahim Kouhsari, Pegah Panahi, Mohammad Sholeh, et al. Minocycline, focus on mechanisms of resistance, antibacterial activity, and clinical effectiveness: Back to the future, Journal of Global Antimicrobial Resistance. 2020;22:161-174, ISSN 2213-7165,

Available:https://doi.org/10.1016/j.jgar.2020.01.022 (https://www.sciencedirect.com/science/article/pii/S2213716520300230)

Nazarian S, Akhondi H. Minocycline. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.

Available:https://www.ncbi.nlm.nih.gov/books/NBK554519/

Ros Forteza FJ, Pereira Marques I. Minocycline-induced intracranial hypertension in a patient with a levonorgestrel intrauterine device. Neurologia (Engl Ed). English, Spanish. 2019;34(8):551-553. DOI: 10.1016/j.nrl.2016.11.012

Angelette AL, Rando LL, Wadhwa RD, Barras AA, Delacroix BM, Talbot NC, et al. Tetracycline, Doxycycline-, Minocycline-Induced Pseudotumor Cerebri and Esophageal Perforation. Adv Ther. 2023; 40(4):1366-1378. DOI: 10.1007/s12325-023-02435-y