Histiocytoid Sweet's Syndrome During Induction Therapy with All-trans Retinoic Acid for Acute Promyelocytic Leukemia: A Case Report

急性前骨髓性白血病接受ATRA治療合併類組織細胞Sweet症候群：病例報告

卓聖里(Sheng-Li Cho) ； 周文堅(Wen-Chien Chou)

《內科學誌》 32卷3期 (2021/06) Pp. 199-203

https://doi.org/10.6314/JIMT.202106_32(3).07

摘要

Histiocytoid Sweet's syndrome is a recently described histopathologic variant of Sweet's syndrome. This is the first case report describing histiocytoid variant of Sweet's syndrome caused by all-trans retinoic acid in a patient with acute promyelocytic leukemia. We present a 30-year-old man with newly diagnosed acute promyelocytic leukemia who received induction chemotherapy containing all-trans retinoic acid and developed fever and painful erythematous cutaneous papules on day 13 of therapy. A diagnosis of histiocytoid Sweet's syndrome was made. All-trans retinoic acid was considered the culprit drug to induce this event. Treatment with corticosteroids improved the systemic and cutaneous signs. A literature search identified only 17 cases of Sweet's syndrome during all-trans retinoic acid therapy, but none were of the histiocytoid variant. The presented clinical course resembles previously reported cases of Sweet's syndrome. This case emphasizes the rare effect of all-trans retinoic acid therapy causing histiocytoid Sweet's syndrome manifesting as fever and skin papules.

關鍵字

Acute promyelocytic leukemia ； Sweet's syndrome ； Retinoic acid ； Drug-related side effects ； Case report

並列摘要

類組織細胞Sweet症候群（Histiocytoid Sweet's syndrome）是近期描述的一種Sweet症候群之組織病理變異型。本病案描述文獻上第一例之由全反維他命A酸（all-trans retinoic acid）在急性前骨髓性白血病病人引起之類組織細胞Sweet症候群。患者為30歲男性，新診斷急性前骨髓性白血病，在接受包含全反維他命A酸的前導性化學治療後第13天產生發燒、疼痛性皮膚丘疹。診斷為由全反維他命A酸引起之類組織細胞Sweet症候群。經由類固醇治療後，系統性及皮膚狀況改善。文獻回顧只有17例由全反維他命A酸在急性前骨髓性白血病病人引起之Sweet症候群，但其中並無案例屬於類組織細胞變異型Sweet症候群。本案例強調全反維他命A酸引起類組織細胞Sweet症候群之罕見副作用，其以發燒及丘疹為臨床表現。