title: Continuation of all-trans retinoic acid despite the development of scrotal ulcerations in a black male.
abstract: Acute promyelocytic leukemia, an aggressive subtype of acute myeloid leukemia, is characterized by the t(15;17) translocation. Standard induction chemotherapy consists of (ATRA) in combination with anthracycline-based chemotherapy with or without the addition of cytarabine. Rare and serious side effects of ATRA have been reported including painful lip and scrotal ulcerations. Of 20 previous reports of genital ulceration, 17 patients had ATRA discontinued and corticosteroids initiated; however, the corticosteroid regimens and duration of therapy were not well described. Herein we present the first known case of a Black male with ATRA-associated scrotal ulcerations who was successfully managed with corticosteroids without cessation of all-trans retinoic acid. We report this case to highlight its rarity and to note that ATRA can be continued in combination with corticosteroids throughout induction.
authors.affiliation: University of North Carolina Hospitals, Department of Pharmacy and Drug Information, Chapel Hill, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Sutherland
authors.affiliation: Aflac Cancer and Blood Disorders Center, Department of Hematology and Medical Oncology, Emory University School of Medicine, USA.
authors.forename: Christine L
authors.initials: CL
authors.lastname: Kempton
authors.affiliation: Grady Health System, Department of Pharmacy and Drug Information, Atlanta, USA mcurry@gmh.edu.
authors.forename: Marjorie Adams
authors.initials: MA
authors.lastname: Curry
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005832:Genital Diseases, Male / Q000139:chemically induced* / Q000473:pathology; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000188:drug therapy; D008297:Male; D012611:Scrotum / Q000473:pathology*; D012883:Skin Ulcer / Q000139:chemically induced* / Q000473:pathology; D014212:Tretinoin / Q000008:administration & dosage / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D014212:Tretinoin
keywords: All-trans retinoic acid; acute promyelocytic leukemia; scrotal ulcerations