title: Lingual ulceration associated with retinoic acid syndrome during treatment of acute promyelocytic leukemia.
abstract: BACKGROUND
  All-trans retinoic acid (ATRA) is routinely associated with chemotherapy for the treatment of acute promyelocytic leukemia (APL). Several reports of scrotal ulceration induced by this agent have been made in the recent years.
  
  
  OBJECTIVE
  The aim of this article was to report the first case of a lingual ulceration associated with retinoic acid syndrome (RAS).
  
  
  METHODS
  We presented a 32-year-old man with a diagnosis of acute promyelocytic leukemia who received treatment with ATRA. He presented with febrile neutropenia and a lingual ulcer that did not respond to antibiotic and antifungal regimens. He developed weight gain, lower limb edema, polyserositis, and acute renal failure. Retinoic acid syndrome syndrome was diagnosed.
  
  
  RESULTS
  An exhaustive attempt to exclude infectious causes was made performing repeated cultures, histologic examinations, and direct immunofluorescence for HSV. No causative agent was identified. Re-epithelialization of the ulcer was achieved with ATRA cessation and treatment with systemic steroids.
  
  
  CONCLUSIONS
  As far as we are concerned, we report the first case of a lingual ulceration associated with RAS.
  
  
  CONCLUSIONS
  It is important for dermatologists to recognize this cutaneous complication of ATRA as it poses many differential diagnoses in neutropenic patients.
authors.affiliation: Department of Dermatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Julia
authors.initials: J
authors.lastname: Riganti
authors.forename: Mariana P
authors.initials: MP
authors.lastname: Caviedes
authors.forename: Ana C
authors.initials: AC
authors.lastname: Torre
authors.forename: Mariana Guzzi
authors.initials: MG
authors.lastname: Maqueda
authors.forename: Maria C Baztan
authors.initials: MC
authors.lastname: Piñero
authors.forename: Victoria I
authors.initials: VI
authors.lastname: Volonteri
authors.forename: Ricardo L
authors.initials: RL
authors.lastname: Galimberti
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D064147:Febrile Neutropenia / Q000139:chemically induced; D006801:Humans; D015255:Idarubicin / Q000008:administration & dosage; D015473:Leukemia, Promyelocytic, Acute / Q000188:drug therapy*; D008297:Male; D019226:Oral Ulcer / Q000139:chemically induced* / Q000473:pathology; D013577:Syndrome; D014060:Tongue Diseases / Q000139:chemically induced* / Q000473:pathology; D014212:Tretinoin / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D014212:Tretinoin; D015255:Idarubicin