Pneumotox » Drug » All-transretinoic acid (ATRA)

All-transretinoic acid (ATRA)

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The PML-RAR inhibitor ATRA or tretinoin can cause the ATRA- or differentiation syndrome with dyspnea, fever, weight gain, hypotension, pulmonary infiltrates and hypoxemia, pulmonary edema, ARDS or DAH w/wo capillaritis. Imaging features at PMID 11804921

Last update : 18/02/2018

I.b Pneumonitis (ILD)

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I.k Lung nodule or nodules

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II.a Pulmonary edema, noncardiogenic (NCPE)

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II.b ARDS - Acute lung injury

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II.f Hypoxemia, low oxygen saturation (may occur in isolation)

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II.k Pulmonary edema/ARDS of the ATRA syndrome (see Xab)

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III.a Alveolar hemorrhage (AH), diffuse AH (DAH)

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V.a Pleural effusion (uni- or bilateral) (can accompany DI-LDs)

2

V.m Pleuropericarditis - Pleuropericardial effusion (ANA unknown or negative)

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VI.a Pulmonary embolism - Venous thrombosis/thromboembolism

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VI.d Pulmonary vasculitis or capillaritis

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X.o Neutrophilic dermatosis (Pyoderma, Sweet syndrome)

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X.ab The differentiation- or ATRA syndrome

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XII.c Pericardial effusion (w/wo tamponade)

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Diagnosing DIRD

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Drug and radiation history

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Drug singularity - Correct identification of the drug

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Consistent timing of exposure v. onset of symptoms

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Clinical, imaging, BAL, pathological pattern consistent with the specific drug

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Careful exlusion of another cause

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Remission of symptoms with removal of drug

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Recurrence with rechallenge (rarely advisable)

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Causality assessment

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