title: Recurrent differentiation syndrome or septic shock? Unresolved dilemma in a patient with acute promyelocytic leukemia.
abstract: Differentiation syndrome (DS) is a life-threatening complication observed in patients with acute promyelocytic leukemia (APL) receiving induction therapy with all-trans-retinoic acid (ATRA). A bimodal incidence of DS has been observed, with a majority of cases occurring during the first week of ATRA treatment ("early" DS), but a substantial number of cases occurring during the third or even fourth week of ATRA treatment ("late" DS). However, to our knowledge occurrence of both early and late DS in the same patient has not been reported. We report an APL patient treated with the AIDA regimen, who experienced both early and late DS, a situation where differential diagnosis was difficult.
authors.affiliation: Hematology Department, Aziza Othmana University Hospital, Tunis, Tunisia. ramzi.jed@voila.fr
authors.forename: Ramzi
authors.initials: R
authors.lastname: Jeddi
authors.forename: Hela
authors.initials: H
authors.lastname: Ghédira
authors.forename: Ramzi Ben
authors.initials: RB
authors.lastname: Amor
authors.forename: Samia
authors.initials: S
authors.lastname: Menif
authors.forename: Zaher
authors.initials: Z
authors.lastname: Belhadjali
authors.forename: Balkis
authors.initials: B
authors.lastname: Meddeb
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002454:Cell Differentiation; D003937:Diagnosis, Differential; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000188:drug therapy*; D008297:Male; D011379:Prognosis; D012008:Recurrence; D012772:Shock, Septic / Q000139:chemically induced / Q000175:diagnosis*; D013577:Syndrome; D014212:Tretinoin / Q000009:adverse effects*
chemical_list: D000970:Antineoplastic Agents; D014212:Tretinoin