Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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A Case of Acute Respiratory Distress Syndrome Induced by All-Trans-Retinoic Acid

ATRA로 유발된 급성호흡곤란증후군 1예

  • Kim, Cheol (Department of Internal Medicine Yonsei University College of Medicine) ;
  • Ko, Won-Ki (Department of Internal Medicine Yonsei University College of Medicine) ;
  • Kwon, Seung-Hyun (Department of Internal Medicine Yonsei University College of Medicine) ;
  • Kang, Shin-Myung (Department of Internal Medicine Yonsei University College of Medicine) ;
  • Kim, Chang-Nyun (Department of Internal Medicine Yonsei University College of Medicine) ;
  • Yang, Dong-Gyoo (Department of Internal Medicine Yonsei University College of Medicine) ;
  • Kim, Se-Kyu (Department of Internal Medicine Yonsei University College of Medicine) ;
  • Chang, Joon (Department of Internal Medicine Yonsei University College of Medicine) ;
  • Kim, Sung-Kyu (Department of Internal Medicine Yonsei University College of Medicine) ;
  • Lee, Won-Young (Department of Internal Medicine Yonsei University College of Medicine) ;
  • Yang, Woo-Ik (Department of Internal Medicine, National Health Insurance Corporation, Ilsan Hospital)
  • 김철 (연세대학교 의과대학 내과학교실) ;
  • 고원기 (연세대학교 의과대학 내과학교실) ;
  • 권승현 (연세대학교 의과대학 내과학교실) ;
  • 강신명 (연세대학교 의과대학 내과학교실) ;
  • 김창년 (연세대학교 의과대학 내과학교실) ;
  • 양동규 (연세대학교 의과대학 내과학교실) ;
  • 김세규 (연세대학교 의과대학 내과학교실) ;
  • 장준 (연세대학교 의과대학 내과학교실) ;
  • 김성규 (연세대학교 의과대학 내과학교실) ;
  • 이원영 (연세대학교 의과대학 내과학교실) ;
  • 양우익 (국민의료보험관리공단 일산병원 내과)
  • Published : 2000.07.30
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Abstract

Acute respiratory distress syndrome (ARDS) has been reported to be associated with a variety of medical and surgical conditions, including All-trans-retinoic acid (ATTA). ATRA is very efficaceous drug to acute promyelocytic leukemia (APL). This drug can induce complete remission at APL without fatal risk of disseminated intravascular coagulation. But ATRA treatment, sometimes, produces the symptoms of fever, weight gain and acute respiratory distress, renal function impairment. The causes of these symptoms are not fully proved, but supposed as the result of leukostasis and capillary leak syndrome from excessive leukocyte differentiation and cytokines release. Recently, we experienced a 24-year-old woman who complained gum bleeding for 6 days. At bone marrow biopsy, she was diagnosed as APL. 2 days after ATRA treatment, she was suffered from the symptoms of dyspnea and general ache. At laboratory examination, total leukocyte count was 50,400/$mm^3$, $PaO_2$ was 42.5 mm Hg and chest PA revealed the findings compatible with ARDS. Treatment with low dose ara-C, corticosteroid and general supportive cares were tried. Within 3 days after treatment, the patient recovered from ARDS by evidence of arterial blood gas study and chest radiographs. She has acquired complete remission of APL with maintenance of A TRA. And so, we present this case with a review of related literatures.

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