Scrotal ulcer occurring in patients with acute promyelocytic leukemia during treatment with all-trans retinoic acid

Although all-trans retinoic acid (ATRA) has been shown to improve the outco me of patients with acute promyelocytic leukemia (APL) compared with chemot herapy alone, various adverse effects have been reported. We report here th e development of scrotal ulcer in four patients with APL during ATRA treatm ent. ATRA 45 mg/m(2) was administered orally to four patients with newly di agnosed APL, two of whom also received chemotherapy. Scrotal ulcers appeare d in all four patients after a median of 22 days (range: 17-29 days) of ATR A treatment. ATRA was discontinued in only one patient, who was then treate d with methylprednisolone pulse therapy. The fever resolved, and scrotal ul cer improved after this treatment. The other three patients were treated wi th steroid of antibiotic ointment for scrotal ulcers. ATRA was re-administe red 2 years later in one patient who had relapse of APL. Ulcers appeared ag ain on the scrotal and lower abdominal skin on day 27 of ATRA treatment. Th ese findings strongly suggest that scrotal ulcer is a potential adverse eff ect of ATRA.