Differentiation Syndrome with Severe Abdominal Pain During Induction Treatment of Acute Promyelocytic Leukemia: A Case Report

Abstract

Background Acute promyelocytic leukemia differentiation syndrome (APL DS) is a common and severe complication seen in patients with APL treated with all-trans retinoic acid (ATRA) and/or arsenic trioxide (ATO). The presenting symptoms of APL DS are diverse, and rare symptoms are easy to be misdiagnosed. Therefore, it is very crucial to identify DS from uncommon signs to avoid delay in treatment. Case Presentation Here, we report a patient of APL who developed severe abdominal pain during ATRA and ATO therapy, with increasing leukocyte count. Organic diseases were firstly excluded, and empiric treatment for DS was adopted. The abdominal pain was gradually relieved and the patient eventually achieved complete remission. Conclusion This case history suggests that APL DS may manifest as severe abdominal pain, and the early identification of DS and immediate treatment could improve the prognosis of patients.

A Brief Review of the Progress of Research on Late Pain Care in Patients with Leukemia

“…In view of the fact that patients with advanced leukemia need to strengthen pain assessment, it is necessary to better understand the pain conditions of different patients through strengthening pain assessment, so as to help patients to treat them [4,5] .…”

Differentiation Syndrome in Acute Leukemia: APL and Beyond

“…Table 1 lists the most common symptoms of DS. In addition to the more commonly seen symptoms of DS in patients with APL, there have been several atypical presentations reported in the literature, including atypical cardiac manifestations, pancreatitis, and ocular manifestations [32,[34][35][36][37][38][39][40]. The atypical cardiac presentations of DS include myocarditis, pericarditis, or myopericarditis [34,[40][41][42].…”