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

Kim, Cheol; Ko, Won Ki; Kwon, Seung Hyun; Kang, Shin Myung; Kim, Chang Nyun; Yang, Dong Gyoo; Kim, Se Kyu; Chang, Joon; Kim, Sung Kyu; Lee, Won Young; Yang, Woo Ik

doi:2000.49.1.93

Tuberc Respir Dis > Volume 49(1); 2000 > Article

Case Report

Tuberculosis and Respiratory Diseases 2000;49(1):93-98.
DOI: https://doi.org/10.4046/trd.2000.49.1.93 Published online July 1, 2000.

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

Cheol Kim, Won Ki Ko, Seung Hyun Kwon, Shin Myung Kang, Chang Nyun Kim, Dong Gyoo Yang, Se Kyu Kim, Joon Chang, Sung Kyu Kim, Won Young Lee, Woo Ik Yang

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.

Key Words: Acute respiratory distress syndrome, All-trans-retinoic acid, Corticosteroid