Continuation of all-trans retinoic acid despite the development of scrotal ulcerations in a black male

Abstract

Acute promyelocytic leukemia, an aggressive subtype of acute myeloid leukemia, is characterized by the t(15;17) translocation. Standard induction chemotherapy consists of (ATRA) in combination with anthracycline-based chemotherapy with or without the addition of cytarabine. Rare and serious side effects of ATRA have been reported including painful lip and scrotal ulcerations. Of 20 previous reports of genital ulceration, 17 patients had ATRA discontinued and corticosteroids initiated; however, the corticosteroid regimens and duration of therapy were not well described. Herein we present the first known case of a Black male with ATRA-associated scrotal ulcerations who was successfully managed with corticosteroids without cessation of all-trans retinoic acid. We report this case to highlight its rarity and to note that ATRA can be continued in combination with corticosteroids throughout induction.