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Mydriasis after the treatment of vindesine in a patient with acute promyelocytic leukemia

Leukemia volume 16, page 1200 (2002)Cite this article

Vindesine (VDS), one of the vinca alkaloids, is widely used as an antineoplastic agent. Possible target sites are microtubules and tubulins in cancer cells. As the adverse effects of VDS, myelosuppression, alopecia and neurotoxicity are well-known. Neurotoxic effects are divided into four categories, peripheral neuropathy, autonomic neuropathy, encephalopathy and cranial nerve neuropathy.1 In autonomic neuropathy, constipation and paralytic ileus are the most frequent manifestations. To our knowledge, there are no previous reports of mydriasis caused by VDS treatment.

In this case, the patient demonstrated mydriasis without disappearance of light and accommodation reflexes. Pupils become miotic by contraction of the papillary constrictor muscle in response to stimuli through the parasympathetic pathway. On the contrary, pupils become mydriatic by the contraction of the papillary dilator muscle in response to stimuli through sympathetic pathway. Mydriasis can be divided into two categories: paralytic mydriasis and spastic mydriasis.4 Paralytic mydriasis occurs by the paralysis of the papillary constrictor muscle due to paralysis of the sympathetic pathway. While spastic mydriasis is caused by spasm of the papillary dilator muscle due to irritation of the sympathetic pathway, and light and accommodation reflexes persist during spastic mydriasis.4 Spastic mydriasis is produced by irritation of the central or cervical sympathetic pathways or efferent nerves caused by spinal tumors, visceral diseases, cerebral tumors or administration of cocaine or adrenalin.4 The administration of VDS induces irritation of the sympathetic nerve, resulting in spastic mydriasis in this case. Vinca alkaloids inhibit the outgrowth of neuritis and induce blockage of neural functions.5 This is the first report that administration of VDS induced mydriasis caused by irritation of the sympathetic pathway.

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  1. Second Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan

    E Ashihara, C Shimazaki, R Takahashi, S Fuchida, N Ochiai, T Inaba & M Nakagawa

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  1. E Ashihara
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  2. C Shimazaki
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  3. R Takahashi
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  6. T Inaba
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  7. M Nakagawa
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Ashihara, E., Shimazaki, C., Takahashi, R. et al. Mydriasis after the treatment of vindesine in a patient with acute promyelocytic leukemia. Leukemia 16, 1200 (2002). https://doi.org/10.1038/sj.leu.2402493

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