614
2020년 제 71차 대한내과학회 추계학술대회
￭S-571 ￭ Acute reversible pericarditis during induction chemotherapy
for acute promyelocytic leukemia
연세대학교 의과대학 내과학교실1, 국민건강보험공단 일산병원 혈액종양내과2
김은영1, 장명희2, 허자윤2
Introduction: Differentiation syndrome (DS), is a common complication observed during induction therapy for acute promyelocytic leukemia (APL). Myopericarditis occurs rarely as a variant form of DS. Here, we report a case of pericarditis after induction therapy consisting of all-trans retinoic acid (ATRA), and anthracycline.
Case: A 22-year old Asian female with unremarkable previous medical history was referred to the hospital with symptoms of sustained fever, both retinal hemorrhage and abnormal lab findings including leukocytosis (33.1x10³/㎕), anemia (3.3g/㎗), thrombocytopenia (40x10³/㎕). Bone marrow examinations were consistent with APL, representing PML-RARA fusion in gene tests. She started induction chemotherapy with ATRA 40 ㎎ twice a day and idarubicin 12 ㎎/㎡ intravenously on day 2, 4, 6, 8. No complication was observed until day 7. Her vital signs were stable and investigations including chest x-ray imaging, ECG (Figure 1A), and cardiac enzymes were within normal limits. On day 8, the patient developed a sharp, piercing epigastric pain during respiration and unexplained sustained fever along with hypotension. ECG revealed diffuse concave upward ST elevation without reciprocal change (Figure 1B) and elevation of serum troponin I levels, demonstrating the typical presentation of acute pericarditis. Echocardiography performed the next day exhibited normal left ventricular (LV) systolic function along with mild pericardial effusion and thickening of the pericardium (Figure 1C). Chest computed tomography scan showed mild pericardial thickening (Figure 1D). After cardiology consultations, we diagnosed pericarditis as a variant form of DS. She was immediately started on dexamethasone IV 10 ㎎ twice a day. Serum troponin I levels normalized after three days of dexamethasone, while the ECG normalized after six days (Figure 1E). The patient recovered completely without sequalae and was subsequently retreated with ATRA without recurrence of the pericarditis.
Conclusion: We have presented a case of pericarditis as a rare manifestation of DS. Similar to other forms of DS, systemic steroid therapy is the treatment of choice.
