J Cardiovasc Ultrasound.  2011 Jun;19(2):95-98. 10.4250/jcu.2011.19.2.95.

Reversible Symptomatic Myocarditis Induced by All-Trans Retinoic Acid Administration during Induction Treatment of Acute Promyelocytic Leukemia: Rare Cardiac Manifestation as a Retinoic Acid Syndrome

• Choi S
• Kim HS
• Jung CS
• Jung SW
• Lee YJ
• Rheu JK
• Jo JR
• Lee NH

• KMID: 1980359
• DOI: http://doi.org/10.4250/jcu.2011.19.2.95

Abstract

Treatment by All-trans retinoic acid (ATRA) followed by anthracycline-AraC chemotherapy has improved the outcome of acute promyelocytic leukemia. ATRA is usually well tolerated, but a few major side effects can be observed. Retinoic acid syndrome (RAS) often occurs during the induction chemotherapy of acute promyelocytic leukemia. A pericardial effusion is a common cardiac manifestation but myocarditis has been rarely documented. Here we reports a very rare case of fully recovered myocarditis as a result of RAS related to ATRA administration during induction treatment of acute promyelocytic leukemia which documented by echocardiographic evidence.

Keyword

Myocarditis; Retinoic acid syndrome; Acute promyelocytic leukemia

MeSH Terms

Induction Chemotherapy
Leukemia, Promyelocytic, Acute
Myocarditis
Pericardial Effusion
Tretinoin
Tretinoin

Figure

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  Fig. 1 Left ventricular (LV) systolic and diastolic dysfunction at retinoic acid syndrome attack. A: Decreased LV systolic function (LV ejection fraction 38%) by LV M-mode. B: Abnormal LV diastolic function (E/Em 13.4) - restrictive LV ventricular filling. LVEDD: LV end systolic diameter, LVESD: LV end systolic diameter, LVEF: left ventricular ejection fraction, E: early diastolic mitral inflow velocity, Em: early diastolic mitral tissue Doppler velocity.

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  Fig. 2 The change of left ventricular (LV) global radial strain at LV mid wall. Comparing baseline LV global radial strain, global radial strain at RAS was decreased -19.2% to -14.5% and color-coded strain pattern form anterior to lateral segmental at mid LV wall was decreased. RAS: retinoic acid syndrome.

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  Fig. 3 64 channel multidetecter CT coronary angiography show no significant obstructive epicardial coronary artery disease.

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