title: Genital ulcers during treatment with ALL-trans retinoic acid for acute promyelocytic leukemia.
abstract: Scrotal ulcer is a unique adverse effect of all-trans retinoic acid (ATRA) in patients with acute promyelocytic leukemia (APL). The pathogenesis of scrotal ulceration remains unknown. We describe genital ulcers that developed in four patients with APL who were undergoing ATRA therapy (45 mg/m2 per day p.o.). Two of the patients were female, in whom this condition is quite rare. Genital ulcers with concomitant fever appeared between 17 and 32 days of therapy in all four patients. Genital ulcers healed in three of the patients while another patient developed Fournier's gangrene and underwent left testectomy. Ulcer healing was brought by either local or intravenous corticosteroids. Intravenous dexamethasone actually enabled continued ATRA administration in one patient, while ATRA was discontinued in other two patients. If corticosteroids cannot control progression of genital ulcers nor concomitant fever, ATRA administration should be discontinued so as not to induce Fournier's gangrene nor retionic acid syndrome. Our experience indicates the importance of recognizing genital ulcers associated with ATRA in order that appropriate countermeasures can be taken.
authors.affiliation: Department of Internal Medicine, Takayama Red Cross Hospital, 3-11 Tenman-cho, Takayama, Gifu 506-8550, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Fukuno
authors.forename: Hisashi
authors.initials: H
authors.lastname: Tsurumi
authors.forename: Hideko
authors.initials: H
authors.lastname: Goto
authors.forename: Masami
authors.initials: M
authors.lastname: Oyama
authors.forename: Shinobu
authors.initials: S
authors.lastname: Tanabashi
authors.forename: Hisataka
authors.initials: H
authors.lastname: Moriwaki
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects*; D005260:Female; D005334:Fever / Q000139:chemically induced; D018934:Fournier Gangrene / Q000209:etiology; D005831:Genital Diseases, Female / Q000139:chemically induced*; D005832:Genital Diseases, Male / Q000139:chemically induced*; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D014212:Tretinoin / Q000009:adverse effects*; D014456:Ulcer / Q000139:chemically induced* / Q000188:drug therapy
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D000970:Antineoplastic Agents; D014212:Tretinoin