tretinoin and Genital-Diseases--Male

Topics: Adult; Antineoplastic Agents; Biopsy; Diagnosis, Differential; Fever; Genital Diseases, Male; Humans; Induction Chemotherapy; Leukemia, Promyelocytic, Acute; Male; Scrotum; Skin; Skin Ulcer; Tretinoin

Acute promyelocytic leukemia, an aggressive subtype of acute myeloid leukemia, is characterized by the t(15;17) translocation. Standard induction chemotherapy consists of (ATRA) in combination with anthracycline-based chemotherapy with or without the addition of cytarabine. Rare and serious side effects of ATRA have been reported including painful lip and scrotal ulcerations. Of 20 previous reports of genital ulceration, 17 patients had ATRA discontinued and corticosteroids initiated; however, the corticosteroid regimens and duration of therapy were not well described. Herein we present the first known case of a Black male with ATRA-associated scrotal ulcerations who was successfully managed with corticosteroids without cessation of all-trans retinoic acid. We report this case to highlight its rarity and to note that ATRA can be continued in combination with corticosteroids throughout induction.

Topics: Antineoplastic Combined Chemotherapy Protocols; Genital Diseases, Male; Glucocorticoids; Humans; Leukemia, Promyelocytic, Acute; Male; Scrotum; Skin Ulcer; Tretinoin; Young Adult

Topics: Adult; Antineoplastic Agents; Genital Diseases, Male; Humans; Leukemia, Promyelocytic, Acute; Male; Scrotum; Tretinoin; Ulcer

All-trans retinoic acid (ATRA) has been shown to improve the outcome in patients with acute promyelocytic leukemia compared with chemotherapy alone, but it is associated with adverse effects. We report the development of scrotal ulcer in a patient with acute promyleocytic leukemia (APL) within 10 days of treatment with ATRA at a dose of 40 mg orally twice daily. The ulcer did not respond to antibiotic treatment and healed shortly after withholding ATRA. The biopsy showed inflammation only, and other microbiological workup was negative.

Topics: Administration, Oral; Adult; Antineoplastic Agents; Genital Diseases, Male; Humans; Leukemia, Promyelocytic, Acute; Male; Scrotum; Skin Ulcer; Tretinoin

All-trans-Retinoic acid (ATRA) has been shown to improve survival in patients with acute promyelocytic leukemia (APML). It is a well-tolerated drug except for the serious side effect of ATRA syndrome. Dryness of the skin, cheilitis, and xerostomia are the common mucocutaneous side effects. Occurrence of scrotal ulceration is very rare. We report a 13-year-old boy who had scrotal ulceration caused by ATRA during the induction therapy of APML.

Topics: Adolescent; Anti-Bacterial Agents; Antineoplastic Agents; Genital Diseases, Male; Humans; Leukemia, Promyelocytic, Acute; Male; Scrotum; Steroids; Tretinoin; Ulcer

Topics: Genital Diseases, Male; Humans; Male; Scrotum; Tretinoin; Ulcer

Scrotal ulcer is a unique adverse effect of all-trans retinoic acid (ATRA) in patients with acute promyelocytic leukemia (APL). The pathogenesis of scrotal ulceration remains unknown. We describe genital ulcers that developed in four patients with APL who were undergoing ATRA therapy (45 mg/m2 per day p.o.). Two of the patients were female, in whom this condition is quite rare. Genital ulcers with concomitant fever appeared between 17 and 32 days of therapy in all four patients. Genital ulcers healed in three of the patients while another patient developed Fournier's gangrene and underwent left testectomy. Ulcer healing was brought by either local or intravenous corticosteroids. Intravenous dexamethasone actually enabled continued ATRA administration in one patient, while ATRA was discontinued in other two patients. If corticosteroids cannot control progression of genital ulcers nor concomitant fever, ATRA administration should be discontinued so as not to induce Fournier's gangrene nor retionic acid syndrome. Our experience indicates the importance of recognizing genital ulcers associated with ATRA in order that appropriate countermeasures can be taken.

Topics: Adrenal Cortex Hormones; Adult; Anti-Inflammatory Agents; Antineoplastic Agents; Female; Fever; Fournier Gangrene; Genital Diseases, Female; Genital Diseases, Male; Humans; Leukemia, Promyelocytic, Acute; Male; Middle Aged; Tretinoin; Ulcer

Induction therapy with all-trans -retinoic acid has been shown to improve the outcome of patients with acute promyelocytic leukemia, although some side effects occur. Dry skin and lips are among the most common cutaneous side effects. We report a case of scrotal ulcerations induced by all-trans -retinoic acid in an American patient; to our knowledge this is the first such case reported.

Topics: Antineoplastic Agents; Genital Diseases, Male; Humans; Leukemia, Promyelocytic, Acute; Male; Middle Aged; Scrotum; Tretinoin; Ulcer

We report the development of painful scrotal ulceration in two patients during treatment with all-trans-retinoic acid (ATRA) for acute promyelocytic leukaemia (APL). ATRA 45 mg/m2 was administered orally for 8 days prior to the addition of standard induction chemotherapy. Painful scrotal ulceration developed in both cases within 2 weeks of therapy (9 and 13 days) and responded slowly to drug withdrawal and systemic, or topical, corticosteroids. A total of 17 APL patients have been treated with ATRA at our institution during the last 10 years, giving an incidence of approximately 12%. The present report, together with a review of literature, suggests that scrotal ulceration is a specific adverse effect of ATRA therapy and that this complication may be more common than previously documented.

Topics: Adrenal Cortex Hormones; Adult; Genital Diseases, Male; Humans; Leukemia, Promyelocytic, Acute; Male; Middle Aged; Scrotum; Tretinoin; Ulcer

Fournier's gangrene is described as a fulminant necrotizing fasciitis of the scrotum and penis. Few cases have been reported in the context of acute leukemia. We describe a case, complicating the induction treatment of an acute promyelocytic leukemia with all-trans-retinoic acid and chemotherapy. The evolution was favorable, following surgical excision and broad-spectrum antibiotic therapy. The respective roles of all-trans-retinoic acid and granulocytopenia are discussed. This devastating and life-threatening infection must be kept in mind for early clinical, bacteriological, and radiological diagnosis and surgical management.

Topics: Adult; Anti-Bacterial Agents; Antineoplastic Agents; Fournier Gangrene; Genital Diseases, Male; Humans; Leukemia, Promyelocytic, Acute; Male; Scrotum; Tretinoin

A 43-year-old man was admitted because of gingival bleeding. A diagnosis of acute promyelocytic leukemia (APL) was made. He was given combination chemotherapy including all-trans retinoic acid (ATRA). During the myelosuppression stage, the patient developed Fournier's gangrene of the scrotum. He achieved complete remission and underwent a hemicastration procedure. Seven months later, bilateral external ear tumors developed. Biopsy specimens of the tumors revealed infiltration of APL cells. A second remission was obtained by chemotherapy including ATRA. However, bilateral ear tumors developed again 5 months later despite indications of normal marrow without proliferation of leukemic blasts. Irradiation successfully reduced the ear tumors, but the patient died of cerebral hemorrhage from a left frontal extramedullary tumor. This was a rare case of APL accompanied by Fournier's gangrene of the scrotum during ATRA treatment, and by extramedullary tumors of the external ear and brain during leukemic relapse.

Topics: Adult; Ear Neoplasms; Fournier Gangrene; Genital Diseases, Male; Humans; Leukemia, Promyelocytic, Acute; Male; Neoplasms, Second Primary; Scrotum; Tretinoin