[Acute promyelocytic leukemia accompanied by scrotal Fournier's gangrene during ATRA treatment and relapsed as external ear tumor].
A 43-year-old man was admitted because of gingival bleeding. A diagnosis of acute promyelocytic leukemia (APL) was made. He was given combination chemotherapy including all-trans retinoic acid (ATRA). During the myelosuppression stage, the patient developed Fournier's gangrene of the scrotum. He achieved complete remission and underwent a hemicastration procedure. Seven months later, bilateral external ear tumors developed. Biopsy specimens of the tumors revealed infiltration of APL cells. A second remission was obtained by chemotherapy including ATRA. However, bilateral ear tumors developed again 5 months later despite indications of normal marrow without proliferation of leukemic blasts. Irradiation successfully reduced the ear tumors, but the patient died of cerebral hemorrhage from a left frontal extramedullary tumor. This was a rare case of APL accompanied by Fournier's gangrene of the scrotum during ATRA treatment, and by extramedullary tumors of the external ear and brain during leukemic relapse.
First Department of Internal Medicine, Gifu University School of Medicine.
H
H
Goto
H
H
Tsurumi
S
S
Kasahara
T
T
Hara
T
T
Yamada
M
M
Sawada
S
S
Tanabashi
M
M
Kametani
H
H
Moriwaki
D000328:Adult; D004428:Ear Neoplasms / Q000209:etiology* / Q000473:pathology; D018934:Fournier Gangrene / Q000209:etiology*; D005832:Genital Diseases, Male / Q000209:etiology; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D016609:Neoplasms, Second Primary / Q000209:etiology* / Q000473:pathology; D012611:Scrotum; D014212:Tretinoin / Q000008:administration & dosage / Q000009:adverse effects*
D014212:Tretinoin