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Lack of efficacy: case report A 19-year-old woman’s condition worsened despite treatment with tretinoin, mannitol and sodium chloride for acute promyelocytic leukaemia [dosages and routes not stated]. The woman presented with progressive fatigue, dyspnoea on exertion and dizziness for 3 weeks. Prior to these symptoms, she had an unknown bug bite 3 weeks ago. She was admitted. On admission, the investigations were indicative of acute promyelocytic leukaemia. She received a dose of tretinoin [ATRA]. She developed a severe headache. Head CT revealed a left temporal lobe intra-parenchymal haemorrhage. Her condition continued to deteriorate despite the use of hypertonic sodium chloride [saline] and mannitol. Within 24 hours of admission, she passed away. Author comment: "(Acute promyelocytic leukaemia) represents an oncologic emergency and often presents with coagulopathy and potentially life threatening hemorrhage. The rate of early death in APL is debated but is estimated at upwards of 30%. Clinically, APL presents with symptoms of pancytopenia; fatigue, dyspnea on exertion, petechia, and infection. Standard therapy includes all-trans retinoic acid (ATRA) in combination with chemotherapy. Adeyemo O, et al. Acute promyelocytic anemia: A case of undiagnosed fatigue. Journal of Hospital Medicine 13 (Suppl. 1): abstr. 426, No. 4, Jan 2018. Available from: URL: https://www.shmabstracts.com/abstract/acute-promyelocytic-anemia-a803432654 case-of-undiagnosed-fatigue/ [abstract] - USA

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Reactions 9 Nov 2019 No. 1778