Delirium in acute promyelocytic leukemia patients: two case reports.
BACKGROUND
Delirium is a frequently misdiagnosed and inadequately treated neuropsychiatric complication most commonly observed in terminally ill cancer patients. To our knowledge this is the first report describing delirium in two patients aged less than 60 years and enrolled in an intensive chemotherapeutic protocol for acute promyelocytic leukemia.


METHODS
Two female Caucasian acute promyelocytic leukemia patients aged 46 and 56 years developed delirium during their induction treatment with all-trans retinoic acid and idarubicin. In both cases symptoms were initially attributed to all-trans retinoic acid that was therefore immediately suspended. In these two patients several situations may have contribute to the delirium: in patient 1 a previous psychiatric disorder, concomitant treatments with steroids and benzodiazepines, a severe infection and central nervous system bleeding while in patient 2 steroid treatment and isolation. In patient 1 delirium was treated with short-term low-doses of haloperidol while in patient 2 non-pharmacologic interventions had a beneficial role. When the diagnosis of delirium was clear, induction treatment was resumed and both patients completed their therapeutic program without any relapse of the psychiatric symptoms. Both patients are alive and in complete remission as far as their leukemia is concerned.


CONCLUSIONS
We suggest that patients with acute promyelocytic leukemia eligible to intensive chemotherapy should be carefully evaluated by a multisciplinary team including psychiatrists in order to early recognize symptoms of delirium and avoid inadequate treatments. In case of delirium, both pharmacologic and non-pharmacologic interventions may be considered.
Unità operativa di Ematologia, Dipartimento Medico Specialistico, Azienda Ospedaliero-Universitaria Arcispedale S, Anna, via Aldo Moro, 8-44124, Cona Ferrara, Italy. gm.rigolin@ospfe.it.
Gian Matteo
GM
Rigolin
Sara
S
Martinelli
Luca
L
Formigaro
Francesca
F
Cibien
Enrico
E
Lista
Maurizio
M
Cavallari
Marco
M
Ambrosio
Miriam
M
Pizzolato
Giulia
G
Daghia
Olga
O
Sofritti
Antonio
A
Cuneo
D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D014150:Antipsychotic Agents / Q000627:therapeutic use; D003693:Delirium / Q000139:chemically induced* / Q000188:drug therapy / Q000523:psychology; D005260:Female; D006220:Haloperidol / Q000627:therapeutic use; D006801:Humans; D015255:Idarubicin / Q000008:administration & dosage / Q000009:adverse effects*; D015473:Leukemia, Promyelocytic, Acute / Q000188:drug therapy / Q000473:pathology / Q000523:psychology*; D008875:Middle Aged; D012074:Remission Induction; D014212:Tretinoin / Q000008:administration & dosage / Q000009:adverse effects*
D000970:Antineoplastic Agents; D014150:Antipsychotic Agents; D014212:Tretinoin; D006220:Haloperidol; D015255:Idarubicin