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All-Trans Retinoic Acid–Induced Myositis and Retinoic Acid Syndrome in Microgranular-Variant Acute Promyelocytic Leukemia

Tae-Young Kim MD, Chi Hoon Maeng MD, PhD, Si-Young Kim MD, PhD, Hwi-Joong Yoon MD, PhD, Kyung Sam Cho MD, PhD, Sun Kyung Baek MD, PhD, Jaeheon Jeong MD, PhD, Tae-Sung Park MD, PhD, Sun Young Min MD, PhD
DOI: http://dx.doi.org/10.1309/LM7FVGTFODMKFJFJ 348-352 First published online: 1 November 2013

Abstract

Acute promyelocytic leukemia (APL) is a subtype of acute myelogenous leukemia (AML). All-trans retinoic acid (ATRA) is an effective drug in the treatment of APL by promoting the terminal differentiation of leukemic cells into phenotypically mature myeloid cells. The microgranular-variant APL counts for a quarter of APL and is similar to monocytic origin leukemia. The microgranular-variant type has no effect on APL treatment. ATRA is related with some serious side effects such as Sweet’s syndrome and retinoic acid syndrome (RAS). Histologic characteristics of RAS are seen in capillary leakage and infiltration of organs by mature myeloid cells. ATRA-induced myositis is rarely described in adults and rare in children with APL. There have been increasing reports of ATRA-induced myositis, with its frequent association with RAS and Sweet’s syndrome. We report a patient with ATRA-induced myositis and RAS in microgranular variant APL and review the previously reported cases in the literature of ATRA-induced myositis.

Keywords:
  • all-trans retinoic acid
  • myositis
  • acute promyelocytic leukemia
  • retinoic acid syndrome
  • microgranular variant
  • adults
  • Abbreviations

    APL
    acute promyelocytic leukemia;
    ATRA
    all-trans retinoic acid;
    RAS
    retinoic acid syndrome;
    FISH
    fluorescence in situ hybridization;
    MRI
    magnetic resonance imaging;
    CK
    creatine kinase;
    ICU
    intensive care unit;
    CT
    computed tomography;
    WBC
    white blood cell
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