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Título

Case report: Patient with intracranial hypertension secondary to the use of ustekinumab.

RESUMO

Case presentation: Patient, 36 years old, male, with a previous diagnosis of Psoriasis and HIV infection. On 05/18/2022 he woke up with a central scotoma in his right eye and a temporal one on the left. He had episodes of blurred vision in the morning during the week prior to the reported symptoms, in addition to episodes of headache in recent months and tinnitus of mild intensity and spontaneous resolution. Last dose of ustekinumab for psoriasis treatment on 05/06/2022. Subjected to retinal mapping that showed papilledema, worse on the right. In brain resonance, no changes were seen. Laboratory tests showed reagent serum FTA-ABS, VDRL 1:2048 and undetectable Viral Load. A diagnosis of syphilis was made and treatment with Intravenous Crystalline Penicillin was initiated. He was subjected to cerebrospinal fluid puncture with opening pressure of 36 cmH20 and result of non-reactive VDRL, FTA ABS IgM and IgG in the cerebrospinal fluid. Treatment with acetazolamide was started. The patient evolved with significant improvement in the described visual symptoms. Discussion: The signs and symptoms of intracranial hypertension include headache, transient visual blurring, amaurosis, papilledema, and diplopia secondary to sixth cranial nerve palsy. Through the analysis of the clinical condition presented, associating it with the results of the complementary exams, as well as the exclusion of other causal factors for intracranial hypertension, a strong correlation between the situation presented by the patient with the use of ustekinumab is suggested.This is a monoclonal antibody, which binds to the p40 subunit of IL-12 and IL-23 so that they are unable to bind to their receptors, reducing T cell-mediated inflammation in psoriasis. The most common adverse reactions are nasopharyngitis, headache and upper respiratory tract infection. Limited data is available on its potential neurological adverse effects. Final comments: Intracranial hypertension associated with the use of ustekinumab is a rare condition. We emphasize the relevance of knowing the medications in use by the patient in order to make a differential diagnosis in patients with clinical manifestations of intracranial hypertension without anatomical alterations. Therefore, performing a complete anamnesis and careful ophthalmological examination is essential to obtain an accurate diagnosis and the adoption of appropriate therapy.

Palavras Chave

Intracranial Hypertension; ustekinumab