tretinoin and Myositis

All-trans retinoic acid has revolutionized the treatment of acute promyelocytic leukemia, but this therapy is often complicated by the all-trans retinoic acid syndrome. Here we report a patient with newly diagnosed acute promyelocytic leukemia who developed acute focal myositis, synovitis, and possible vasculitis, after receiving all-trans retinoic acid therapy. We review the existing literature on this rare clinical entity, all-trans retinoic acid-induced myositis. This condition can manifest as fever, myalgia, arthralgia, and Sweet syndrome, accompanied by distinct magnetic resonance findings involving the lower extremity musculature. Treatment consists of discontinuation of the offending drug and often high dose corticosteroids.

Topics: Adrenal Cortex Hormones; Antineoplastic Agents; Female; Humans; Leukemia, Promyelocytic, Acute; Middle Aged; Mononeuropathies; Myositis; Synovitis; Treatment Outcome; Tretinoin; Withholding Treatment

Topics: Adult; Anti-Inflammatory Agents; Antineoplastic Agents; Dexamethasone; Female; Humans; Leukemia, Promyelocytic, Acute; Myositis; Sweet Syndrome; Tretinoin

To investigate the expression of retinoic acid-I inducible gene I (RIG-I) in the muscle tissues from patients with idiopathic inflammatory myopathies (IIMs), and to speculate the possible role of RIG-I in the immunopathogenesis of IIMs.. Muscle specimens were obtained from 20 dermatomyositis (DM) and 20 polymyositis (PM) patients who underwent muscle biopsies from February 2010 to April 2014 at Qilu hospital affiliated to Shandong University. Besides, 4 facioscapulohumeral muscular dystrophy (FSHD), and 4 non-myopathic patients were taken as control group. All the biopsy specimens were processed with hematoxylin-eosin and immunohistochemical (Mouse anti human RIG-I antibodies) staining. We also examined the co-localization of RIG-I and CD303, which is the specific surface marker of plasmacytoid dendridic cells (pDCs), by means of double immunofluorescence staining. Western blot was performed for quantitative analysis.. There was strong expression of RIG-I protein in DM/PM muscle tissues while in normal controls was virtually absent. RIG-I was specifically expressed in inflammatory cells and vessel endothelium, and nonspecifically expressed in regenerating and necrotic fibers. Besides, strong positive expression was observed in the perimysial perifascicular fibers of DM. In FSHD muscle tissues, only a few regenerating and necrotic fibers was stained nonspecifically for RIG-I. However, co-expression of RIG-I and CD303 was not detected in DM/PM muscles. The mean grey value of RIG-I observed in DM (0.901 ± 0.470) and PM (0.630 ± 0.444) group was significantly higher than in control group including Normal (0.003 ± 0.003) and FSHD (0.019 ± 0.013) groups (P < 0.05).. RIG-I may operate as a mediator in Th1 cytokine-I induced chemokine expression, so it is involved in the pathogenesis of IIMs. But RIG-I may not play a major role in innate immune reaction mediated by type I interferon.

Topics: Biopsy; Blotting, Western; Cytokines; DEAD Box Protein 58; DEAD-box RNA Helicases; Humans; Myositis; Receptors, Immunologic; Tretinoin

All-trans retinoic acid (ATRA), a component of standard therapy for acute promyelocytic leukemia (APL), is associated with potentially serious but treatable adverse effects involving numerous organ systems, including rare skeletal muscle involvement. Only a handful of cases of ATRA-induced myositis in children have been reported, and none in the radiology literature. We present such a case in a 15-year-old boy with APL, where recognition of imaging findings played a crucial role in making the diagnosis and facilitated prompt, effective treatment.

Topics: Adolescent; Antineoplastic Agents; Contrast Media; Dexamethasone; Diagnosis, Differential; Gadolinium; Glucocorticoids; Humans; Image Enhancement; Leukemia, Promyelocytic, Acute; Magnetic Resonance Imaging; Male; Myositis; Thigh; Treatment Outcome; Tretinoin

Topics: Child, Preschool; Female; Humans; Leukemia, Promyelocytic, Acute; Myositis; Tretinoin

Topics: Adult; Antineoplastic Agents; Diffusion Magnetic Resonance Imaging; Female; Humans; Leukemia, Promyelocytic, Acute; Myositis; Tretinoin

Anthracyclin-based regimens and all-transretinoic acid (ATRA, tretinoin) as differentiating agent are commonly utilized for the treatment of acute promylelocytic leukemia (APL). There are many adverse effects that may be seen during the use of ATRA in patients with APL. Of these, ATRA-induced myositis is rarely described in adults and rare in the children with APL. Herein, we report an 11-year-old girl with APL who developed ATRA-induced myositis during induction treatment.

Topics: Adult; Antineoplastic Agents; Child; Female; Humans; Leukemia, Promyelocytic, Acute; Myositis; Tretinoin

Topics: Antineoplastic Agents; Humans; Leukemia, Promyelocytic, Acute; Male; Middle Aged; Muscle, Skeletal; Myocarditis; Myositis; Tretinoin

The use of all-trans retinoic acid (ATRA) is now standard therapy for the treatment of acute promyelocytic leukaemia (APML). There have been increasing reports of ATRA-induced myositis, with its frequent association with retinoic acid syndrome and Sweet's syndrome. We report a case of a young man with APML who developed ATRA-induced myositis characterized by unexplained fevers, bilateral leg swelling and a non-painful purpuric, petechial rash, with prompt resolution of symptoms and signs with high-dose steroids and cessation of ATRA. Rapid recognition of this adverse reaction and prompt institution of steroids is of prime importance given its potentially fatal course.

Topics: Adult; Exanthema; Fever; Humans; Leukemia, Promyelocytic, Acute; Male; Myositis; Steroids; Tretinoin

Topics: Adolescent; Anti-Inflammatory Agents; Antineoplastic Combined Chemotherapy Protocols; Dexamethasone; Female; Humans; Idarubicin; Leukemia, Promyelocytic, Acute; Magnetic Resonance Imaging; Muscle, Skeletal; Myositis; Radionuclide Imaging; Thigh; Tretinoin

All-trans-retinoic acid (ATRA) induces complete clinical remissions in a high proportion of patients with acute promyelocytic leukemia and has become the standard induction therapy. Its use as a single agent results in short-lived remissions; thus, cytotoxic drugs are used for "consolidation" therapy. Side effects reported during treatment with ATRA include retinoic acid syndrome and Sweet's syndrome. Sweet's syndrome has been associated with acute myelogenous leukemia at presentation, but only two cases of Sweet's syndrome involving the musculoskeletal system in patients treated with ATRA have been described. We describe two additional patients with acute promyelocytic leukemia who had unexplained fever and myalgias (cutaneous lesions in one patient) during induction therapy with ATRA. Radiologic findings were similar to those in previously reported ATRA-associated Sweet's syndrome of the musculoskeletal system. The clinical course was characterized by a rapid resolution of the symptoms during treatment with dexamethasone. Recognition of the syndrome is important, especially considering the rapid resolution of symptoms after early institution of therapy with corticosteroids.

Topics: Adult; Dexamethasone; Female; Fever; Humans; Leukemia, Promyelocytic, Acute; Magnetic Resonance Imaging; Male; Muscle, Skeletal; Myositis; Sweet Syndrome; Tretinoin

Topics: Adult; Humans; Leukemia, Myeloid, Acute; Male; Myositis; Tretinoin