title: Genital vasculitis secondary to all-trans-retinoic-acid.
abstract: Acute promyelocytic leukaemia is among the most curable haematological malignancies after the introduction of differentiating agents (arsenic trioxide (ATO) and all-trans-retinoic-acid (ATRA)). Despite excellent cure rates, approaching 85-95% in various series, APL is associated with significant early mortality and morbidity. ATRA-related side effects partly contribute to this morbidity, which commonly presents as differentiation syndrome, pseudo tumour cerebri, dermatitis, gastrointestinal disorders, liver dysfunction (raised transaminases) and dryness of skin/eyes. Rarely, ATRA can lead to hypercalcaemia, genital vasculitis, erythaema nodosum and Sweet's syndrome. We present two cases of ATRA-associated genital vasculitis while being managed with a combination of ATO with ATRA therapy. Both patients developed these lesions despite being on prophylactic steroids (0.5 mg/kg). We also discuss the pathophysiology, clinical manifestations, differential diagnosis and treatment of genital vasculitis as a rare adverse event of ATRA.
authors.affiliation: Department of Internal Medicine, Armed Forces Medical College, Pune, Maharashtra, India Department of Internal Medicine (Clinical Hematology Division), Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Uday
authors.initials: U
authors.lastname: Yanamandra
authors.affiliation: Department of Internal Medicine (Clinical Hematology Division), Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Alka
authors.initials: A
authors.lastname: Khadwal
authors.affiliation: Department of Histopathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
authors.forename: Uma Nahar
authors.initials: UN
authors.lastname: Saikia
authors.affiliation: Department of Internal Medicine (Clinical Hematology Division), Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Malhotra
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols; D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000627:therapeutic use; D005260:Female; D005835:Genitalia / Q000473:pathology*; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010087:Oxides / Q000627:therapeutic use; D014212:Tretinoin / Q000009:adverse effects* / Q000627:therapeutic use; D014657:Vasculitis / Q000209:etiology* / Q000473:pathology
chemical_list: D000970:Antineoplastic Agents; D001152:Arsenicals; D010087:Oxides; D014212:Tretinoin; D000077237:Arsenic Trioxide