A 28-year-old man with newly diagnosed acute promyelocytic leukemia started on all-trans retinoic acid develops fever, dyspnea, bilateral pulmonary infiltrates, pleural effusion, and weight gain on day 4 of therapy. Which is the most appropriate immediate management?

• A Stop ATRA permanently and switch to arsenic trioxide alone
• B Broad-spectrum antibiotics for hospital-acquired pneumonia
• C Immediate bone marrow biopsy to assess relapse
• D Dexamethasone while continuing ATRA ✓

Explanation

This is retinoic acid differentiation syndrome (differentiation syndrome), caused by cytokine release from maturing promyelocytes, typically within the first weeks of ATRA or arsenic. The standard approach is high-dose dexamethasone, and ATRA is generally continued unless the syndrome is life threatening. Antibiotics are added only if infection cannot be excluded, but they do not treat the syndrome. Relapse assessment is irrelevant at day 4.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.