Retinoic 산 증후군 1 예 = A Case of Retinoic Acid Syndrome in a Acute Promyelocytic Leukemia Patient Treated with All - trans - Retinoic Acid

다국어 초록 (Multilingual Abstract)

All-trans-retinoic acid(ATBA) is the very efficaceous drug to acute promyelocytic leukemia (APL). This drug can induce complete remission at APL without fatal risk of disseminated intravascular coagulation, Hut, ATRA treatment, sometimes, produces the symptoms of fever, weight gain, myalgia, arthralgia, acute respiratory distress and renal funcation impairment. These findings are called as retinoic acid syndrome. The causes of these symptoms are not fully proved, but supposed as the result of leukostasis and capillary leak syndrome from excessive leukocyte differentiaion & cytokine release. Recently, we experienced a 44-years-old woman who complained gum bleeding for 7 days. At bone marrow biopsy, she was diagnosed as APL. So, we tried ATRA therapy. But, 2 days after ATRA treatment, she was suffered from the symptoms of high fever, weight gain, general ache, respiratory distress, oligouria. At laboratory examination, total leukocyte count was 38,000/ill, PaO2 was 55 mmHg and chest PA revealed the findings compatible with pulmonary edema. Therefore, we could diagnose this patient as retinoic acid syndrome and treatment with low dose ara-C, dexamethasone and general supportive cares were tried. But, this patient was died at 25 days after treatment for retinoic acid syndrome. Lung necropsy was done for searching the cause of respiratory distress. We could see the findings of diffuse alveolar damage with type 2 pneumocyte hypertrophy and pink-colored materials at intraalveolar space without the invasion of leukemic cells at alveolar septum, And so, we present this case with a review of related literatures.