A 48-year-old male diagnosed with APL started on alltrans-retinoic acid (ATRA) and arsenic trioxide (ATO) as per protocol, 1 on Day 2 he started to have fever, dyspnea, and hemoptysis. Chest X-ray (CXR) showed bilateral infiltration (Figure 1), and the patient was started on dexamethasone, based on suspicion of differentiation syndrome. The patient improved significantly within 24 h, and follow-up CXR showed resolution of infiltrates (Figure 2). Diagnosis of differentiation syndrome requires 3 or more of clinical features: fever>38 c, weight gain >5 kg, hypotension, dyspnea, radiographic opacities, pleural or pericardial effusion, and acute renal failure. 2
A 48-year-old male diagnosed with Acute promyelocytic leukemia (APL)
started on all-trans retinoic acid and arsenic trioxide, developed
typical symptoms of differentiation syndrome, and improved dramatically
on steroids. Hence, any APL patient started on chemotherapy, needs to be
monitored closely for developing differentiation syndrome and to start
steroid upon suspicion.
A 56-year-old male known to have Primary Myelofibrosis (PMF) on
ruxolitinib presented with flank pain and high creatinine, MRI abdomen
showed features of extramedullary hematopoiesis. Therefore,
Extramedullary hematopoiesis should be considered in patient with PMF
presenting with deranged renal function.
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