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目的讨论并鉴别全反式维甲酸(ATRA)引起的少见的不良反应,提高急性早幼粒细胞白血病(APL)早期治疗的效果。方法报告国内首例 ATRA 治疗 APL 并发 Sweet’s 综合征的病例,并进行相关文献复习。结果文献报道共有13例 APL 患者发生与 ATRA 治疗相关的 Sweet’s 综合征。包括本例在内的14例患者,中位年龄49.5(9～84)岁,女10例,男4例。10例患者单独累及皮肤,4例除皮肤外还累及肌肉、肺部、肾脏。皮肤累及以上肢为多(11例),其他部位包括下肢、面部、颈部、背部、腹部、会阴部等。患者出现 Sweet’s 综合征时,ATRA 治疗中位时间为18(6～34)d,外周血中位白细胞计数为7.05(0.80～23.00)×10~9/L。有4例患者未中断 ATRA 治疗,共有13例患者给予糖皮质激素治疗,12例有效。1例患者自发缓解。在全部14例患者中,有2例出现维甲酸综合征。结论Sweet’s 综合征为 ATRA 治疗 APL 患者过程中少见的并发症,与皮肤组织的炎症和感染不易鉴别,其发生的机制与维甲酸综合征之间的关系尚不清楚。糖皮质激素治疗有效,再次应用 ATRA 后未见复发。
Objective To discuss and identify the rare adverse reactions caused by all-trans retinoic acid (ATRA) and to improve the efficacy of early treatment of acute promyelocytic leukemia (APL). Methods The report of the first ATRA treatment of APL complicated with Sweet’s syndrome cases, and review of relevant literature. Results A total of 13 APL patients were reported to have Sweet’s syndrome associated with ATRA treatment. Including this case, including 14 patients, the median age of 49.5 (9 to 84) years, 10 females, 4 males. Ten patients had skin involvement alone, and four had muscle, lung and kidney involvement in addition to the skin. Skin involving the upper limbs and more (11 cases), other parts, including the lower extremities, face, neck, back, abdomen, perineum and so on. Patients with Sweet’s syndrome, the median time of ATRA treatment was 18 (6 ~ 34) d, peripheral blood leukocyte count was 7.05 (0.80 ~ 23.00) × 10 ~ 9 / L. Four patients did not discontinue ATRA treatment, a total of 13 patients were treated with glucocorticoid, 12 were effective. One patient spontaneously remission. In all 14 patients, 2 developed retinoic acid syndrome. Conclusions Sweet’s syndrome is a rare complication in the treatment of APL patients by ATRA. It is not easily distinguished from inflammation and infection of skin tissues. The relationship between the mechanism and retinoic acid syndrome is not yet clear. Glucocorticoid treatment effective, no recurrence after ATRA application again.