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Am. J. Respir. Crit. Care Med., Volume 158, Number 4, October 1998, 1302-1305

Diffuse Alveolar Hemorrhage with Underlying Pulmonary Capillaritis in the Retinoic Acid Syndrome

MARK R. NICOLLS, LANCE S. TERADA, RUBIN M. TUDER, SHEILA A. PRINDIVILLE, and MARVIN I. SCHWARZ

Division of Pulmonary Sciences and Critical Care Medicine, Department of Pathology, Division of Hematology and Oncology, and Department of Medicine, University of Colorado Health Sciences Center, Denver, Colorado

All-trans-retinoic acid (ATRA) can induce a clinical remission in patients with acute promyelocytic leukemia. An adverse condition called "retinoic acid syndrome" limits this therapy. It is characterized by fever and respiratory distress, along with weight gain, pleural or pericardial effusions, peripheral edema, thromboembolic events, and intermittent hypotension. The lung disease has been previously ascribed to an infiltration of leukemic or maturing myeloid cells into lung parenchyma, which is sometimes associated with pleural effusions and diffuse alveolar hemorrhage. We report a case of retinoic acid syndrome in an 18-yr-old woman who developed diffuse alveolar hemorrhage while being treated with ATRA for acute promyelocytic leukemia. An open lung biopsy revealed pulmonary capillaritis.




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