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Year : 2020  |  Volume : 3  |  Issue : 2  |  Page : 97-99

Retinoic acid syndrome followed by scrotal ulcer during treatment of acute promyelocytic leukemia with all-trans retinoic acid

Department of Medicine, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India

Correspondence Address:
Dr. Nishil Gowda
Department of Medicine, Pt. B.D. Sharma PGIMS, Rohtak 124001, Haryana
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jco.jco_11_20

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All-trans-retinoic acid (ATRA) has shown a significant improvement in the outcome of patients of acute promyelocytic leukemia and is associated with certain unique adverse effects. We report one such case of APL, who developed ATRA syndrome on day 7 of ATRA, which was relieved after ATRA withdrawal and dexamethasone therapy. Subsequently, with the reintroduction of ATRA, patient developed an unexplained fever which was followed by multiple painless ulcers over the scrotum on day 28 of ATRA. ATRA was withdrawn so as not to induce Fournier’s gangrene, and ulcers were closely monitored without the administration of systemic or local corticosteroids. Eventually, ulcers improved and completely healed by 4 weeks. This is a rare case report, wherein the same patient develops ATRA syndrome followed by scrotal ulcers, suggesting that the scrotal ulcer is a rare specific adverse effect of ATRA and its monitoring is required especially in patients having unexplained fever and leucocytosis.

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