Idiopathic Intracranial Hypertension Secondary to Methotrexate in a Young Child with Juvenile Idiopathic Arthritis: A Rare Case Report

Idiopathic Intracranial Hypertension (IIH) is characterised by the signs and symptoms of increased intracranial pressure, but where a causative mass or hydrocephalus is not identified. It is also known as pseudotumor cerebri, a rare neurological disorder in children, which, if not treated properly, may lead to severe visual dysfunction. A 6-year-old male child presented with a 2-month history of progressively increasing joint pain and intermittent low-grade fever. After comprehensive evaluation and ruling out infectious, malignant, and systemic autoimmune disorders, the diagnosis of Juvenile Idiopathic Arthritis (JIA) was established and the Disease-Modifying Anti-Rheumatic Drug (DMARDs) for management drug Methotrexate was initiated. On follow-up, the child was diagnosed to have IIH for which, after detailed investigation, no cause was found and then it was ascribed to be caused by methotrexate and hence the drug was withheld. He was started on Acetazolamide subsequent to which there was resolution of symptoms. Clinicians should be aware of a potential, although rare, side effect of DMARDs like methotrexate and advise caregivers of children with chronic disorders like JIA to be on regular follow-up for early recognition of serious side effects, which would thereby halt any potential fatal or life-altering condition.