Scrotal ulcer occurring in patients with acute promyelocytic leukemia during treatment with all-trans retinoic acid.

Scrotal ulceration during induction therapy of acute promyelocytic leukemia with ATRA

“…They reported three patients in whom the lesion appeared slightly earlier (ranging from day 7 to day 13). In one of these patients who relapsed with APML 2 years later, re-administration of ATRA caused recurrence of similar lesions indicating a close association between ATRA and scrotal ulceration rather than a chance occurrence [5]. Except in three cases, ATRA was continued and the scrotal lesions resolved gradually.…”

“…Later Tajima et al [4] and Mori et al [5] reported seven similar cases from Japan occurring 9-29 days after ATRA treatment. The occurrence of similar lesions in Caucasian was first described by Charles et al [6] and Esser et al [7].…”

“…Resolution of the lesions following administration of steroids or discontinuation of ATRA supports this. The other propositions are that the ulcer results from cytokine release [5] or from production of superoxide [6].…”

Treatment of Acute Promyelocytic Leukemia by Retinoids

“…Other side effects, including bone marrow necrosis [11], hypercalcemia [122], erythema nodosum [123], marked basophilia [124,125], severe myositis [126], Sweet syndrome [127,128], Fournier's gangrene (necrotizing fasciitis of the penis and scrotum) [129,130], thrombocytosis [131], and necrotizing vasculitis [132] have rarely been reported with ATRA treatment.…”

Isolated Foot Ulcer Complicating Acute Leukemia: An Unusual Manifestation of Herpes Simplex Virus Infection Simulating Pyoderma Gangrenosum

“…A viral etiology has rarely been incriminated except for otherwise typical lesions [6]. On rare occasions, cutaneous ulcerations have been reported after treatment with hydroxyurea or all-trans-retinoic acid in patients with myeloid leukemias [7,8].…”