TOXIC NEUROPATHY AS A RARE OPHTHALMIC COMPLICATION OF ISOTRETINOIN THERAPY (CLINICAL CASE)

Abstract

Despite the high efficacy of isotretinoin in the treatment of acne, isotretinoin therapy is associated with a significant number of side effects and can sometimes lead to less frequent, but clinically more significant and potentially unpredictable complications.

Purpose – a clinical case demonstrates the development of toxic neuropathy as a rare ophthalmic complication of systemic isotretinoin therapy.
A young girl aged 17 complained of deteriorating vision in her left eye four months after starting isotretinoin therapy. She complained of a foggy feeling and shadow on the nasal side of her left eye. Ophthalmoscopy: OS – optic nerve disc (OND) is covered by hemorrhage, in some places the traceable boundaries are blurred, peripapillary edema extending to the foveolar zone. Soft exudates could be observed around the OND. The retinal vessels are tortuous, the veins are tense and full-blooded. Multiple intraretinal hemorrhages of various size could be noted throughout the retinal surface. OD – the fundus is normal, without pathological changes. A marked narrowing of the visual field of the left eye on the nasal side to 20 degrees could be noted, while the right one with no pathological changes. Optical coherence tomography (OCT) revealed severe swelling of the OND and macular area. During the patient's examination we performed a general and biochemical blood tests along with the detailed coagulogram, a blood test for infections and a brain magnetic resonance imaging (MRI) with angiography. The MRI revealed no pathological changes, and all test results were within normal limits. A neuropathologist, hematologist and dermatologist also consulted the patient with recommendations to stop taking isotretinoin and start taking systemic glucocorticosteroids. Apparently, in our case, an increased dose of the medication in recent months has become the reason for the toxic effect and, accordingly, an excessive cumulative dose relative to the teenager’s weight.

Conclusion
The clinical case presented demonstrates the development of toxic neuropathy as a rare ophthalmic complication of systemic isotretinoin therapy. Timely discontinuation of the medication and administration of pathogenetic therapy made it possible to achieve a gradual regression of morphological changes and improvement of visual functions.