Introducción
All-trans retinoic acid (RA) belongs to a class of chemical compounds structurally related to vitamin A. RA induces terminal differentiation of abnormal promyelocytes in acute promyelocytic leukemia (APL), and the use of RA is the first line treatment for leukemia. The most serious complication of the RA-based therapy is retinoic acid syndrome (RAS). The onset of the syndrome ranges from 2 to 21 days (median period of 10 days) after initiating RA therapy. Respiratory distress and unexplained fever are most common manifestations in the syndrome, and others were pulmonary edema, pulmonary infiltrates, pleural effusion, pericardial effusion, hypotension and acute renal failure.
Post-mortem studies have suggested that series of events in RAS probably result in damage of the microvasculature because similar findings are seen in a variety of diseases, including trauma, sepsis, and adult respiratory distress syndrome (ARDS).
