Tuberc Respir Dis.  2000 Jul;49(1):93-98. 10.4046/trd.2000.49.1.93.

A Case of acute respiratory distress syndrome induced by all-trans-retinoic acid

• Kim C
• Ko WK
• Kwon SH
• Kang SM
• Kim CN
• Yang DG
• Kim SK
• Chang J
• Kim SK
• Lee WY
• Yang WI

• KMID: 2160258
• DOI: http://doi.org/10.4046/trd.2000.49.1.93

Abstract

Acute respiratory distress syndrome (ARDS) has been reported to be associated with a variety of medical and surgical conditions, including All-trans-retinoic acid (ATTA). ATRA is very efficaceous drug to acute promyelocytic leukemia (APL). This drug can induce complete remission at APL without fatal risk of disseminated intravascular coagulation. But ATRA treatment, sometimes, produces the symptoms of fever, weight gain and acute respiratory distress, renal function impairment. The causes of these symptoms are not fully proved, but supposed as the result of leukostasis and capillary leak syndrome from excessive leukocyte differentiation and cytokines release. Recently, we experienced a 24-year-old woman who complained gum bleeding for 6 days. At bone marrow biopsy, she was diagnosed as APL. 2 days after ATRA treatment, she was suffered from the symptoms of dyspnea and general ache. At laboratory examination, total leukocyte count was 50,400/mm3 PaO2 was 42.5 mmHg and chest PA revealed the findings compatible with ARDS. Treatment with low dose ara-C, corticosteroid and general supportive cares were tried. Within 3 days after treatment, the patient recovered from ADRD by evidence of arterial blood gas study and chest radiographs. She has acquired complete remission of APL with maintenance of ATRA. And so, we present this case with a review of related literatures.

Keyword

Acute respiratory distress syndrome; All-trans-retinoic acid; Corticosteroid

MeSH Terms

Biopsy
Bone Marrow
Capillary Leak Syndrome
Cytarabine
Cytokines
Disseminated Intravascular Coagulation
Dyspnea
Female
Fever
Gingiva
Hemorrhage
Humans
Leukemia, Promyelocytic, Acute
Leukocyte Count
Leukocytes
Leukostasis
Radiography, Thoracic
Respiratory Distress Syndrome, Adult*
Thorax
Tretinoin*
Weight Gain
Young Adult
Cytarabine
Cytokines
Tretinoin