Myocarditis secondary to holo-transretinoic acid in a pediatric patient with acute promyelocytic leukemia

Miocarditis secundaria al ácido holo-transretinoico en paciente pediátrico con leucemia promielocítica aguda

Introduction: Acute promyelocytic leukemia is a type of acute myeloid leukemia, the standard treatment for which is the use of ATRA in combination with chemotherapy. Adverse effects have been reported with the use of ATRA, however, cardiovascular consequences have not yet been reported in Colombia, making this the first case of myocarditis due to ATRA in Colombia, during the treatment of a patient with acute promyelocytic leukemia. Clinical case: Female school patient admitted with bicytopenia and changes in flow cytometry compatible with APL. With genetic confirmation by FISH for translocation 15;17. Treatment was started with ATRA at 30 mg/m2/day and idarubicin. After twenty days of treatment, thrombocytopenia with altered coagulation times persisted, so the ATRA dose was adjusted to 40 mg/m2/day, after which the patient presented chest pain, hemodynamic instability, hydroelectrolytic alteration, elevated troponin and atrial peptide. An echocardiogram was performed, showing altered myocardial contraction, valvular failure and alveolar infiltrate on chest x-ray. Given the clinical, laboratory and imaging findings, ATRA myocarditis was considered. Conclusion: ATRA therapy can be considered safe and with few adverse effects, however, higher doses in the pediatric population can be associated with symptoms of chest pain, elevated cardiac biomarkers, as well as echocardiographic changes that should alert professionals of a possible myocardial alteration. However, the differential diagnosis of ATRA differentiation syndrome should be ruled out as another possible cause given its higher prevalence reported in the literature.