Erythema multiforme due to arsenic trioxide in a case of acute promyelocytic leukemia: A diagnostic challenge.
Erythema multiforme (EM) is an acute, self-limited, Type IV hypersensitivity reactions associated with infections and drugs. In this case of acute promyelocytic leukemia, EM diagnosed during the induction phase was mistakenly attributed to vancomycin used to treat febrile neutropenia during that period. However, the occurrence of the lesions of EM again during the consolidation phase with arsenic trioxide (ATO) lead to a re-evaluation of the patient and both the Naranjo and World Health Organization-Uppsala Monitoring Centre scale showed the causality association as "probable." The rash responded to topical corticosteroids and antihistamines. This rare event of EM being caused by ATO may be attributed to the genetic variation of methyl conjugation in the individual which had triggered the response, and the altered metabolic byproducts acted as a hapten in the subsequent keratinocyte necrosis.
Institute of Hematology and Transfusion Medicine, Kolkata, West Bengal, India.
Girish V
GV
Badarkhe
Department of Pharmacology, Institute of Postgraduate Education and Research, Kolkata, West Bengal, India.
Amrita
A
Sil
Department of Dermatology, Medical College, Kolkata, West Bengal, India.
Sabari
S
Bhattacharya
Institute of Hematology and Transfusion Medicine, Kolkata, West Bengal, India.
Uttam Kumar
UK
Nath
Department of Dermatology, Medical College, Kolkata, West Bengal, India.
Nilay Kanti
NK
Das
D000328:Adult; D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000009:adverse effects*; D004892:Erythema Multiforme / Q000139:chemically induced*; D005260:Female; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000188:drug therapy*; D010087:Oxides / Q000009:adverse effects*
D001152:Arsenicals; D010087:Oxides; D000077237:Arsenic Trioxide
Acute promyelocytic leukemia; arsenic trioxide; erythema multiforme; genetic variation