071 Double trouble: papilloedema secondary to idiopathic intracranial hypertension and aplastic anaemia

Objective We report the case of a 34-year-old female diagnosed concurrently with idiopathic intracranial hypertension (IIH) and aplastic anaemia.

Case A 34-year-old female with recent weight gain presented with headache and fatigue. Clinical examination revealed conjunctival pallor and occasional bruising, with fundoscopy and optic coherence tomography demonstrating bilateral papilloedema (grade III). There were enlarged blind spots bilaterally. The cerebrospinal fluid (CSF) opening pressure was greater than 30 cmH₂O. An MRI brain was normal and there was no venous sinus thrombosis. A diagnosis of IIH was made, and she was treated with therapeutic removal of CSF, acetazolamide and weight loss strategies. Concurrently, a bone marrow biopsy to investigate profound panyctopaenia was consistent with aplastic anaemia. The patient had worsening IIH features during fertility preservation treatment in preparation for stem cell transplant. At five months, there was complete resolution of subretinal fluid and clinical papilloedema. Anti-thymocyte globulin and cyclosporine treatment was subsequently commenced.

Conclusion Previous case reports have emphasised the interplay between the pathophysiology of anaemia and IIH,¹ with treatment of aplastic anaemia contributing to resolution of IIH.^2,3 We believe this is the first reported case of concomitant IIH and aplastic anaemia with resolution of papilloedema prior to treatment of anaemia. We also highlight the challenges of managing IIH during fertility and cyclosporine treatment.

References

1. Biossue V, et al. Anaemia and papilledema. American Journal of Ophthalmology 2003;135(4):437.

2. Nazir SA, et al. Pseudotumor cerebri in idiopathic aplastic anemia. Journal of AAPOS 2003;7(1):71.

3. Lilley ER, Bruggers CS, Pollock SC. Papilledema in a patient with aplastic anemia. Arch Ophthalmol 1990;108:1674–5.