Cardiac tamponade and cardiogenic shock as a manifestation of all-trans retinoic acid syndrome: an association not previously reported

Abstract

Since the discovery of the differentiating activity of all-trans retinoic acid (ATRA) in acute promyelocytic leukemia (APL), the treatment of this disease has greatly improved. Currently, the combination of ATRA and chemotherapy is considered the best treatment for patients with APL. This approach has consistently extended the remission rate and disease-free survival of APL patients with low mortality. Among ATRA's adverse effects, the retinoic acid syndrome is the most important. It consists of fever, dyspnea, weight gain, pulmonary infiltrates and pleural and cardiac effusions. Other findings occasionally described are lower extremities edema and leukocytosis. We report a case of an retinoic acid syndrome associated with cardiac tamponade due to massive pericardial effusion. This adverse effect, not previously reported, was successfully treated by performing pericardiocentesis followed by the administration of dexamethasone.