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All trans-retinoic acid differentiation syndrome: case report A 28-year-old man developed all trans-retinoic acid (ATRA) differentiation syndrome during treatment with tretinoin and isotretinoin for acute promyelocytic leukaemia (APL). The man presented to the emergency department, with a 1-week history of fatigue, epistaxis and low-grade fever. Following investigations, APL was suspected. Bone marrow procedure was deferred as he was planned for immediate referral. Owing to unavailability of tretinoin [all trans-retinoic acid], he received oral isotretinoin [Accutane] 30mg twice daily, after 48 hours of presentation. Bone marrow results indicated that his condition improved after isotretinoin treatment. Following a referral to another center, bone marrow biopsy was performed, and the diagnosis of APL was confirmed by molecular and cytogenetics. He then received treatment with tretinoin [dosage and route not stated]. However, he developed ATRA differentiation syndrome immediately after the first dose of tretinoin [times to reaction onset not stated]. Unspecified chemotherapy was added to ongoing tretinoin regimen. Eventually, he achieved complete remission of underlying APL [outcome of reaction not stated]. Alkhaldy HY, et al. Isotretinoin is active in the initial management of acute pro-myelocytic leukemia. Leukemia Research Reports 14: 1-3, Aug 2020. Available from: URL: 803507282 http://doi.org/10.1016/j.lrr.2020.100220

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Reactions 17 Oct 2020 No. 1826