Capillary leak syndrome induced by acitretin

Abstract

The mucocutaneous side-effects of systemic retinoids are well known. We report a patient with diffuse oedema, which is a very rare side-effect of retinoids. The pathophysiology of this condition is poorly known because of the rarity of relevant observations, but apparently corresponds to capillary leak syndrome. The outcome is invariably favourable following withdrawal of the drug, which should be definitively contraindicated in the patient.

Acitretin induced bipedal edema

“…There are a number of case reports of edema occurring in patients taking systemic retinoids. Acitretin was described to cause a capillary leak syndrome with generalized edema in one case 3 . Etretinate, in dosages of 0.3–1.0 mg/kg daily, has been described as the cause of generalized edema in six cases, 4–8 the onset of which varied from days to months with resolution within 2 weeks of stopping the medication.…”

Acute respiratory distress syndrome complicating generalized pustular psoriasis (psoriasis-associated aseptic pneumonitis)

“…Capillary leak syndrome induced by acitretin has been reported in patients with psoriasis. 13,14 However, in our case, acitretin was a highly unlikely cause as the patient had been receiving this treatment for the past 10 years, and the clinical presentation is somewhat different, with weight gain and diffuse edema. 13 Methotrexate was given for only 2 months and was stopped before the onset of respiratory symptoms.…”

“…13,14 However, in our case, acitretin was a highly unlikely cause as the patient had been receiving this treatment for the past 10 years, and the clinical presentation is somewhat different, with weight gain and diffuse edema. 13 Methotrexate was given for only 2 months and was stopped before the onset of respiratory symptoms. Moreover, there was no circulating eosinophilia, and cutaneous pustulation is not a complication of methotrexate hypersensitivity, as noted by Abou-Samra et al 9 Thus methotrexate hypersensitivity was ruled out.…”

Probable fatal drug interaction between intravenous fenretinide, ceftriaxone, and acetaminophen: a case report from a New Approaches to Neuroblastoma (NANT) Phase I study

“…The onset of fever with elevated LDH and ALT on Day 4, prior to starting ceftriaxone and acetaminophen, suggests that some hepatocellular injury may have occurred with fenretinide alone, but was likely exacerbated by these concomitant medications. The clinical generalized capillary leakage seen in this patient has been reported with infection, drug injury, multi-organ failure, and rarely with other retinoids [18]. …”