Objective:

NA

Background:

Intracranial hypertension may be primary (idiopathic) or secondary to some underlying conditions like intracranial space occupying lesions. There are several drugs like tetracycline, sulfamethoxazole, and gentamicin which are associated with raised intracranial pressure. Fluoroquinolones has bactericidal activity against mycobacterium tuberculosis and is an important drug in the treatment of multidrug-resistant tuberculosis (MDR-TB).

Design/Methods:

We are reporting a case of MDR-TB, who was on antitubercular therapy (Bedaquiline, Linezolid, Levofloxacin, Cycloserine, Clofazamine, Pyridoxine) had developed holocranial headache and binocular diplopia for eight days. There was no history of photophobia, phonophobia, lacrimation, redness, ocular pain, or diminution of vision. Examination revealed normal visual acuity and bilateral papilledema. Rest of the systemic examination was within normal limit.

Results:

Cerebrospinal fluid study was unremarkable except raised opening pressure (36 cm of water). Magnetic resonance imaging revealed left transverse and sigmoid sinus stenosis. A probable diagnosis of levofloxacin induced intracranial hypertension was made and the drug was stopped. The symptoms resolved within one week of levofloxacin cessation and the papilledema resolved within 2 weeks. Patient continued the regimen for MDR-TB with substitution of levofloxacin by pyrazinamide. There was no recurrence of symptoms during further follow-up.

Conclusions:

Levofloxacin, a fluoroquinolone, is commonly used for respiratory/urinary tract infection or as antitubercular therapy. It can rarely cause increase in intracranial pressure. Hence, one should have a high index of suspicion while evaluating a case with features of raised intracranial pressure, unremarkable investigation findings and taking levofloxacin as part of therapy.