Differentiation syndrome-induced Myopericarditis in the induction therapy of acute Promyelocytic leukemia: a case report

Abstract Background All trans retinoic acid (ATRA) has revolutionized the treatment and outcomes of patients with Acute Promyelocytic Leukemia (APL). Induction therapy with ATRA is associated with the rare but potentially fatal complication of differentiation syndrome. While the presentation of this...

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Autores principales:	Shabari Mangalore Shenoy, Thomas Di Vitantonio, Anna Plitt, Rocio Perez-Johnston, Jillian Gutierrez, David A. Knorr, Eytan M. Stein, Jennifer E. Liu, Stephanie Feldman
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Myopericarditis Differentiation syndrome All trans retinoid acid Arsenic trioxide Acute Promyelocytic leukemia Diseases of the circulatory (Cardiovascular) system RC666-701 Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/7a32f9335a8a4ac5b0c141e82e7328e5
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spelling	oai:doaj.org-article:7a32f9335a8a4ac5b0c141e82e7328e52021-11-28T12:38:31ZDifferentiation syndrome-induced Myopericarditis in the induction therapy of acute Promyelocytic leukemia: a case report10.1186/s40959-021-00124-92057-3804https://doaj.org/article/7a32f9335a8a4ac5b0c141e82e7328e52021-11-01T00:00:00Zhttps://doi.org/10.1186/s40959-021-00124-9https://doaj.org/toc/2057-3804Abstract Background All trans retinoic acid (ATRA) has revolutionized the treatment and outcomes of patients with Acute Promyelocytic Leukemia (APL). Induction therapy with ATRA is associated with the rare but potentially fatal complication of differentiation syndrome. While the presentation of this syndrome is varied, myopericarditis as a manifestation of differentiation syndrome is often fatal and rarely reported in literature. We present a case of myopericarditis as the sole manifestation of differentiation syndrome in a patient on induction therapy with ATRA and arsenic trioxide for APL. Clinical presentation A 62 year old woman with remote history of breast and uterine cancer presented to the hospital for expedited work up of easy bruising and expanding hematomas. She was diagnosed with APL with peripheral blood and bone marrow cytogenetics revealing t (15;17) translocation and initiated on induction therapy with ATRA and ATO as well as steroids for differentiation syndrome prophylaxis. Eighteen days into induction therapy, patient developed pleuritic chest pain, elevated cardiac biomarkers, ECG changes suggestive of pericarditis. Cardiac magnetic resonance imaging showed patchy multifocal sub-epicardial late gadolinium enhancement and elevated T2 signal consistent with acute myopericarditis. Given the timing of symptom onset and lack of other identifiable cause, patient was diagnosed with differentiation syndrome- induced myopericarditis and promptly initiated on high dose steroids with rapid improvement in symptoms, ECG, and cardiac biomarkers. Patient successfully resumed dose-reduced ATRA and arsenic trioxide without complication. Conclusion Myopericarditis can be the sole manifestation of differentiation syndrome and the presentation may be atypical owing to the use of prophylactic steroids as illustrated in our patient’s case. A high index of suspicion for differentiation syndrome, multimodality imaging, and prompt input from multidisciplinary providers is crucial for making the timely diagnosis and initiating life-saving treatment.Shabari Mangalore ShenoyThomas Di VitantonioAnna PlittRocio Perez-JohnstonJillian GutierrezDavid A. KnorrEytan M. SteinJennifer E. LiuStephanie FeldmanBMCarticleMyopericarditisDifferentiation syndromeAll trans retinoid acidArsenic trioxideAcute Promyelocytic leukemiaDiseases of the circulatory (Cardiovascular) systemRC666-701Neoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENCardio-Oncology, Vol 7, Iss 1, Pp 1-4 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Myopericarditis Differentiation syndrome All trans retinoid acid Arsenic trioxide Acute Promyelocytic leukemia Diseases of the circulatory (Cardiovascular) system RC666-701 Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	Myopericarditis Differentiation syndrome All trans retinoid acid Arsenic trioxide Acute Promyelocytic leukemia Diseases of the circulatory (Cardiovascular) system RC666-701 Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Shabari Mangalore Shenoy Thomas Di Vitantonio Anna Plitt Rocio Perez-Johnston Jillian Gutierrez David A. Knorr Eytan M. Stein Jennifer E. Liu Stephanie Feldman Differentiation syndrome-induced Myopericarditis in the induction therapy of acute Promyelocytic leukemia: a case report
description	Abstract Background All trans retinoic acid (ATRA) has revolutionized the treatment and outcomes of patients with Acute Promyelocytic Leukemia (APL). Induction therapy with ATRA is associated with the rare but potentially fatal complication of differentiation syndrome. While the presentation of this syndrome is varied, myopericarditis as a manifestation of differentiation syndrome is often fatal and rarely reported in literature. We present a case of myopericarditis as the sole manifestation of differentiation syndrome in a patient on induction therapy with ATRA and arsenic trioxide for APL. Clinical presentation A 62 year old woman with remote history of breast and uterine cancer presented to the hospital for expedited work up of easy bruising and expanding hematomas. She was diagnosed with APL with peripheral blood and bone marrow cytogenetics revealing t (15;17) translocation and initiated on induction therapy with ATRA and ATO as well as steroids for differentiation syndrome prophylaxis. Eighteen days into induction therapy, patient developed pleuritic chest pain, elevated cardiac biomarkers, ECG changes suggestive of pericarditis. Cardiac magnetic resonance imaging showed patchy multifocal sub-epicardial late gadolinium enhancement and elevated T2 signal consistent with acute myopericarditis. Given the timing of symptom onset and lack of other identifiable cause, patient was diagnosed with differentiation syndrome- induced myopericarditis and promptly initiated on high dose steroids with rapid improvement in symptoms, ECG, and cardiac biomarkers. Patient successfully resumed dose-reduced ATRA and arsenic trioxide without complication. Conclusion Myopericarditis can be the sole manifestation of differentiation syndrome and the presentation may be atypical owing to the use of prophylactic steroids as illustrated in our patient’s case. A high index of suspicion for differentiation syndrome, multimodality imaging, and prompt input from multidisciplinary providers is crucial for making the timely diagnosis and initiating life-saving treatment.
format	article
author	Shabari Mangalore Shenoy Thomas Di Vitantonio Anna Plitt Rocio Perez-Johnston Jillian Gutierrez David A. Knorr Eytan M. Stein Jennifer E. Liu Stephanie Feldman
author_facet	Shabari Mangalore Shenoy Thomas Di Vitantonio Anna Plitt Rocio Perez-Johnston Jillian Gutierrez David A. Knorr Eytan M. Stein Jennifer E. Liu Stephanie Feldman
author_sort	Shabari Mangalore Shenoy
title	Differentiation syndrome-induced Myopericarditis in the induction therapy of acute Promyelocytic leukemia: a case report
title_short	Differentiation syndrome-induced Myopericarditis in the induction therapy of acute Promyelocytic leukemia: a case report
title_full	Differentiation syndrome-induced Myopericarditis in the induction therapy of acute Promyelocytic leukemia: a case report
title_fullStr	Differentiation syndrome-induced Myopericarditis in the induction therapy of acute Promyelocytic leukemia: a case report
title_full_unstemmed	Differentiation syndrome-induced Myopericarditis in the induction therapy of acute Promyelocytic leukemia: a case report
title_sort	differentiation syndrome-induced myopericarditis in the induction therapy of acute promyelocytic leukemia: a case report
publisher	BMC
publishDate	2021
url	https://doaj.org/article/7a32f9335a8a4ac5b0c141e82e7328e5
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Differentiation syndrome-induced Myopericarditis in the induction therapy of acute Promyelocytic leukemia: a case report

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