Severe Multiorgan Failure Associated with Differentiation Syndrome in a High-risk Acute Promyelocytic Leukemia Patient with Concurrent Influenza A
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.
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BibTeX
@article{yoshimoto2026severe,
title = {{Severe Multiorgan Failure Associated with Differentiation Syndrome in a High-risk Acute Promyelocytic Leukemia Patient with Concurrent Influenza A}},
author = {Sunami Yoshimoto and Naoto Imoto and Haruki Koketsu and Tomoyoshi Wakayama and Shun Ukai and Rie Ito and Shingo Kurahashi},
journal = {Internal Medicine},
year = {2026},
month = aug,
doi = {10.2169/internalmedicine.7565-26},
url = {https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_7565-26/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Severe Multiorgan Failure Associated with Differentiation Syndrome in a High-risk Acute Promyelocytic Leukemia Patient with Concurrent Influenza A
AU - Sunami Yoshimoto
AU - Naoto Imoto
AU - Haruki Koketsu
AU - Tomoyoshi Wakayama
AU - Shun Ukai
AU - Rie Ito
AU - Shingo Kurahashi
PY - 2026
DA - 2026/08/25
JO - Internal Medicine
DO - 10.2169/internalmedicine.7565-26
UR - https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_7565-26/_article
AB - 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.
SN - 1349-7235
SN - 0918-2918
ER -