Diffuse alveolar hemorrhage with underlying pulmonary capillaritis in the retinoic acid syndrome

Am J Respir Crit Care Med. 1998 Oct;158(4):1302-5. doi: 10.1164/ajrccm.158.4.9709085.


All-trans-retinoic acid (ATRA) can induce a clinical remission in patients with acute promyelocytic leukemia. An adverse condition called "retinoic acid syndrome" limits this therapy. It is characterized by fever and respiratory distress, along with weight gain, pleural or pericardial effusions, peripheral edema, thromboembolic events, and intermittent hypotension. The lung disease has been previously ascribed to an infiltration of leukemic or maturing myeloid cells into lung parenchyma, which is sometimes associated with pleural effusions and diffuse alveolar hemorrhage. We report a case of retinoic acid syndrome in an 18-yr-old woman who developed diffuse alveolar hemorrhage while being treated with ATRA for acute promyelocytic leukemia. An open lung biopsy revealed pulmonary capillaritis.

Publication types

  • Case Reports
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Antineoplastic Agents / adverse effects*
  • Capillaries / drug effects
  • Edema / chemically induced
  • Female
  • Fever / chemically induced
  • Hemoptysis / chemically induced*
  • Humans
  • Hypotension / chemically induced
  • Leukemia, Promyelocytic, Acute / drug therapy
  • Lung / blood supply*
  • Pericardial Effusion / chemically induced
  • Pleural Effusion / chemically induced
  • Pulmonary Alveoli / drug effects*
  • Respiratory Insufficiency / chemically induced
  • Syndrome
  • Thromboembolism / chemically induced
  • Tretinoin / adverse effects*
  • Vasculitis / chemically induced*
  • Weight Gain


  • Antineoplastic Agents
  • Tretinoin