Penile Ulcer Atra Related in Patient with Acute Promyelocytic Leukemia

Dear editor, Addition of all-transretinoic acid (ATRA) to antracyclines has been a turning point in the treatment of acute promyelocytic leukemia raising the worldwide complete remission r than 80%. However, a few new side effects have emerged.[1] Among side effects, d syndrome (DS), formerly known as retinoic acid syndrome, is the main life complication of therapy with differentiating agents [all-trans retinoic acid (ATRA) or arsenic trioxide (ATO)].[1] Mild skin side effects including dry skin, xerostomia, cheilitis are also frequent but are not of clinical importance; however ulcerations, more frequently described at the scrotum, [1-4] may rarely occur. Our patient, a 29-year-old man, presented gingival bleeding and was diagnos promyelocytic leukemia through bone marrow and genetic assessment. He was started on cytosine arabinoside, idarubicin and 45 mg/m combination chemotherapy. On treatment day 14, a painless ulcer with a diameter of 1 cm, with an erythematous base emerged on the patient penis (Figure 1). His history included oral aphthae and acne on his back. The patient’s anti HIV and VDRL tests were negative and eye examination was normal. The Pathergy test performed for Behcet's disease was negative Culture for haemophilus ducreyi was negative, as