Distinct Characteristics of Sweet’s Syndrome of the Scrotum Caused by All-trans Retinoic Acid in a Patient with Acute Promyelocytic Leukemia
Induction therapy with all-trans retinoic acid (ATRA) is effective for acute promyelocytic leukemia (APL). ATRA induces neutrophil differentiation and its associated side effects. The differentiation syndrome is the most characterized ATRA-induced adverse effect. Sweet’s syndrome, also known as neut...
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| Format: | Article |
| Language: | English |
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Karger Publishers
2021-10-01
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| Series: | Case Reports in Oncology |
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| Online Access: | https://www.karger.com/Article/FullText/516798 |
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| author | Osamu Imataki Shunsuke Yoshida Tomohiro Kaji Jun-ichiro Kida Hiroyuki Kubo Makiko Uemura Haruyuki Fujita Norimitsu Kadowaki |
| author_facet | Osamu Imataki Shunsuke Yoshida Tomohiro Kaji Jun-ichiro Kida Hiroyuki Kubo Makiko Uemura Haruyuki Fujita Norimitsu Kadowaki |
| author_sort | Osamu Imataki |
| collection | DOAJ |
| description | Induction therapy with all-trans retinoic acid (ATRA) is effective for acute promyelocytic leukemia (APL). ATRA induces neutrophil differentiation and its associated side effects. The differentiation syndrome is the most characterized ATRA-induced adverse effect. Sweet’s syndrome, also known as neutrophilic dermatosis, is another form of ATRA-associated disease characterized by neutrophil infiltrating erythema that develops with fever. This is a case of a 34-year-old Japanese man diagnosed with APL. At the onset, the patient did not have skin involvement of APL cells. He was treated with ATRA and induction chemotherapy with idarubicin and cytarabine. Scrotal skin rash occurred at day 14, which developed into scrotal ulceration up to day 28 even after eliminating APL cells in his peripheral blood. Sweet’s syndrome is a pathological diagnosis of scrotal skin ulceration representing neutrophil infiltration. The infiltrating neutrophils showed PML-RARα rearrangement. The patient was diagnosed with ATRA-associated Sweet’s syndrome with skin ulcer. His cutaneous lesion did not respond to intravenous prednisolone therapy; thereby, ATRA was discontinued. After the cessation of ATRA, the skin lesion improved in the next week. We confirmed he achieved a complete response after induction chemotherapy. In our observation, ATRA-associated Sweet’s syndrome is characterized by the following clinical manifestations: preferable occurrence in the scrota, tend to progress into skin ulcer, and pathogenicity associated with PML-RARα-positive matured neutrophils. The etiology, pathogenesis, and risk factors of ATRA-associated scrotal ulceration were discussed in the literature review. |
| first_indexed | 2024-04-11T20:49:47Z |
| format | Article |
| id | doaj.art-18cacf218ef143fb971bd916cf1a0bba |
| institution | Directory Open Access Journal |
| issn | 1662-6575 |
| language | English |
| last_indexed | 2024-04-11T20:49:47Z |
| publishDate | 2021-10-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | Case Reports in Oncology |
| spelling | doaj.art-18cacf218ef143fb971bd916cf1a0bba2022-12-22T04:03:53ZengKarger PublishersCase Reports in Oncology1662-65752021-10-011431466147410.1159/000516798516798Distinct Characteristics of Sweet’s Syndrome of the Scrotum Caused by All-trans Retinoic Acid in a Patient with Acute Promyelocytic LeukemiaOsamu Imatakihttps://orcid.org/0000-0001-5332-1316Shunsuke YoshidaTomohiro KajiJun-ichiro KidaHiroyuki KuboMakiko UemuraHaruyuki FujitaNorimitsu KadowakiInduction therapy with all-trans retinoic acid (ATRA) is effective for acute promyelocytic leukemia (APL). ATRA induces neutrophil differentiation and its associated side effects. The differentiation syndrome is the most characterized ATRA-induced adverse effect. Sweet’s syndrome, also known as neutrophilic dermatosis, is another form of ATRA-associated disease characterized by neutrophil infiltrating erythema that develops with fever. This is a case of a 34-year-old Japanese man diagnosed with APL. At the onset, the patient did not have skin involvement of APL cells. He was treated with ATRA and induction chemotherapy with idarubicin and cytarabine. Scrotal skin rash occurred at day 14, which developed into scrotal ulceration up to day 28 even after eliminating APL cells in his peripheral blood. Sweet’s syndrome is a pathological diagnosis of scrotal skin ulceration representing neutrophil infiltration. The infiltrating neutrophils showed PML-RARα rearrangement. The patient was diagnosed with ATRA-associated Sweet’s syndrome with skin ulcer. His cutaneous lesion did not respond to intravenous prednisolone therapy; thereby, ATRA was discontinued. After the cessation of ATRA, the skin lesion improved in the next week. We confirmed he achieved a complete response after induction chemotherapy. In our observation, ATRA-associated Sweet’s syndrome is characterized by the following clinical manifestations: preferable occurrence in the scrota, tend to progress into skin ulcer, and pathogenicity associated with PML-RARα-positive matured neutrophils. The etiology, pathogenesis, and risk factors of ATRA-associated scrotal ulceration were discussed in the literature review.https://www.karger.com/Article/FullText/516798all-trans retinoic acidpml-rarαdifferentiation syndromesweet syndromeneutrophil infiltrationscrotal ulcerationacute promyelocytic leukemia |
| spellingShingle | Osamu Imataki Shunsuke Yoshida Tomohiro Kaji Jun-ichiro Kida Hiroyuki Kubo Makiko Uemura Haruyuki Fujita Norimitsu Kadowaki Distinct Characteristics of Sweet’s Syndrome of the Scrotum Caused by All-trans Retinoic Acid in a Patient with Acute Promyelocytic Leukemia Case Reports in Oncology all-trans retinoic acid pml-rarα differentiation syndrome sweet syndrome neutrophil infiltration scrotal ulceration acute promyelocytic leukemia |
| title | Distinct Characteristics of Sweet’s Syndrome of the Scrotum Caused by All-trans Retinoic Acid in a Patient with Acute Promyelocytic Leukemia |
| title_full | Distinct Characteristics of Sweet’s Syndrome of the Scrotum Caused by All-trans Retinoic Acid in a Patient with Acute Promyelocytic Leukemia |
| title_fullStr | Distinct Characteristics of Sweet’s Syndrome of the Scrotum Caused by All-trans Retinoic Acid in a Patient with Acute Promyelocytic Leukemia |
| title_full_unstemmed | Distinct Characteristics of Sweet’s Syndrome of the Scrotum Caused by All-trans Retinoic Acid in a Patient with Acute Promyelocytic Leukemia |
| title_short | Distinct Characteristics of Sweet’s Syndrome of the Scrotum Caused by All-trans Retinoic Acid in a Patient with Acute Promyelocytic Leukemia |
| title_sort | distinct characteristics of sweet s syndrome of the scrotum caused by all trans retinoic acid in a patient with acute promyelocytic leukemia |
| topic | all-trans retinoic acid pml-rarα differentiation syndrome sweet syndrome neutrophil infiltration scrotal ulceration acute promyelocytic leukemia |
| url | https://www.karger.com/Article/FullText/516798 |
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