Severe Multiorgan Failure Associated with Differentiation Syndrome in a High-risk Acute Promyelocytic Leukemia Patient with Concurrent Influenza A.

Authors

Sunami Yoshimoto, Naoto Imoto, Haruki Koketsu, Tomoyoshi Wakayama, Shun Ukai, Rie Ito, Shingo Kurahashi

Published in

Internal medicine (Tokyo, Japan). Aug 25, 2026. Epub Aug 25, 2026.

Abstract

Differentiation syndrome (DS) is rarely observed before treatment in patients with acute promyelocytic leukemia (APL). A 35-year-old man with high-risk APL and influenza A presented with multiple organ failure (MOF). Initially attributed to influenza, the DS-like symptoms rapidly worsened after the initiation of all-trans retinoic acid. Despite intensive care and continuous hemodialysis, the patient developed a cerebral hemorrhage. Consequently, dose-adjusted arsenic trioxide (ATO; 0.1 mg/kg/day) was administered. He achieved complete remission (CR) on day 28 and maintained molecular CR for 16 months without sequelae. Concurrent infections can mask DS-like symptoms prior to treatment. Reduced-dose ATO is an effective salvage option for patients with APL and severe MOF.

PMID:
42649059
Bibliographic data and abstract were imported from PubMed on 27 Aug 2026.

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