pseudotumor cerebri ( ptc ) , is a neurological disorder that is characterized by increased intracranial pressure in the absence of a tumor or other diseases . it affects predominantly obese women of childbearing age with male to female ratio of 1 : 8 . however , childhood cases are not rare and till date about 770 cases of childhood ptc have been reported . present hypothesis is resistance to cerebrospinal fluid ( csf ) outflow at the arachnoid granulations that line the dural venous sinuses through which csf reabsorption occurs , is responsible for ptc . the common risk factors for development of ptc include female sex of reproductive age group , obesity , recent weight gain , menstrual irregularity . several medications have been reported to cause ptc including cimetidine , corticosteroids , danazol , isotretinoin , levothyroxine , lithium , minocycline , nalidixic acid , nitrofurantoin , tamoxifen , tetracyclines , trimethoprim - sulfamethoxazole , levonorgestrel implant , recombinant human growth hormone , vitamin a etc.[411 ] however , there is no case report of ptc due to acitretin found through pubmed search . here we report a case where a child with recalcitrant pustular psoriasis developed ptc showing significant temporal association of occurrence of ptc with intake of acitretin . a 12-years - old boy with generalized pustular psoriasis attended the outpatient department of a tertiary care hospital of eastern india . initially he was treated with methotrexate for two months in the local hospital with inadequate response and was referred to us . when he attended to us , more than 70% of the body surface area showed tenderness , erythema and were studded with pustules . after baseline investigations we put the patient on 25 mg of acitretin per day . after 10 days the dosage was increased to 35 mg / day . after one month of acitretin therapy the pustular lesions were gone and significant improvement in erythema and scaling was noticed . after one and half month , the patient complained of nausea , headache and vomiting . a diagnosis of ptc was suspected and the patient was sent for ophthalmological checkup , which revealed papilledema . his complete blood count , esr , liver function test , renal function test , chest x - ray , routine urine examination were within normal limits . lumber puncture and cerebrospinal fluid examination revealed no abnormality although measurement of exact csf pressure could not be done in our set up . based on history , clinical features , and laboratory findings diagnosis of ptc was made . he was put on intravenous mannitol , oral acetazolamide and systemic corticosteroid . the symptoms like nausea , diplopia , and headache waned within three days . gradually , the dose of systemic steroid was tapered off and the patient was put on cyclosporine . with cyclosporine dose 2.5mg / kg , psoriasis acitretin , a second generation synthetic retinoid , has several dermatological indications including psoriasis , congenital ichthyoses and keratoderma , palmoplantar pustulosis , darier disease , pityriasis rubra pilaris , lichen planus , lichen sclerosus , hyperkeratotic hand eczema and prevention of malignancy . though in case of chronic plaque psoriasis acitretin is effective but it is mostly implicated in the treatment of generalized pustular psoriasis . a study by ozawa a. et al described that the responsiveness of pustular psoriasis to methotrexate was 76% , for cyclosporine it was 71% while the responsiveness was 84% for acitretin . those include teratogenicity , dry eye , reduced night vision , premature epiphyseal closure , dyslipidemia , pancreatitis , leucopenia , agrnaulocytosis , hepatic and renal impairment , myopathy , pseudotumour cerebri etc . pseudotumor cerebri is a neurological disorder that is characterized by increased intracranial pressure in absence of any space occupying lesion . risk factors for the development of ptc include female with child bearing age group , endocrinal disturbances and ingestion of certain medications including cimetidine , corticosteroids , danazol , isotretinoin , levothyroxine , lithium , minocycline , nalidixic acid , nitrofurantoin , tamoxifen , tetracycline , trimethoprim - sulfamethoxazole , levonorgestrel implant , recombinant human growth hormone , vitamin a etc.[411 ] although isotretinion have been commonly reported to cause pseudotumor cerebri in young adult women treated for acne , there is paucity of data regarding occurrence of ptc in relation to acitretin . here we present the case where significant temporal association of acitretin with ptc was found in a child who was treated with this medication for recalcitrant pustular psoriasis . considering the seriousness of the condition , we did not reintroduced acitretin in this patient . with through history taking , clinical examination and available laboratory investigations we could not found any other etiology for this constellation of symptoms . after the discontinuation of the drug , considering severity of pustular psoriasis , cyclosporine was introduced . within few days his clinical condition had improved without any further aggravation of ptc . due to lack of logistic support , detection of the drug concentration in the body fluid hence , according to naranjo casualty assessment scale the association of ptc due to acitretin in our case is probable . the case is reported for its rarity in occurrence and associated significant morbidity including visual loss if not diagnosed and treated immediately .
pseudotumor cerebri ( ptc ) is a rare neurological disorder characterized by increased intracranial pressure in absence of any intra - cranial space - occupying lesion . 
 it is mostly due to impairment of drainage of csf from arachnoid villi . 
 clinically pseudotumor cerebri presents with headache , diplopia , nausea , vomiting , papilloedema and if treatment is delayed , may lead to blindness . 
 females of childbearing age group , endocrinal abnormalities and ingestion of certain drugs have been reported to be associated with pseudotumor cerebri . 
 however , it 's occurrence in relation to acitretin ingestion has not been reported on pubmed database . here 
 we present a case where significant temporal association of acitretin intake with ptc was found in a child who was being treated with this medication for recalcitrant pustular psoriasis . 
 the case is reported for its rarity in occurrence and associated significant morbidity including visual loss if not diagnosed and treated immediately . according to naranjo adr causality scale of adverse drug reaction , the association of ptc due to acitretin in our case was probable .