All-trans retinoic acid (ATRA) is the standard induction treatment for acute promyelocytic leukemia (APL). Renal involvement sometimes necessitates a dose reduction or discontinuation of induction therapy for hematological malignancies. We report here on a case of APL that achieved complete remission with low-dose ATRA treatment despite the patient's acute renal failure. A 42-year-old woman presented with a 2 month history of ecchymosis and she was subsequently diagnosed with APL. During induction treatment with ATRA and idarubicin, oliguria developed and her azotemia rapidly progressed. Because of the progressive deterioration in her general condition, the patient was transferred to the intensive care unit. We started renal replacement therapy for her acute renal failure and we discontinued ATRA treatment. Her urine output started to increase, and there was an improvement in the patient's general condition. We resumed low-dose ATRA treatment. She achieved complete remission after 52 days of treatment.
Acute Kidney Injury* ; Adult ; Azotemia ; Ecchymosis ; Female ; Hematologic Neoplasms ; Humans ; Idarubicin ; Intensive Care Units ; Leukemia, Promyelocytic, Acute* ; Oliguria ; Remission Induction* ; Renal Insufficiency ; Renal Replacement Therapy ; Tretinoin*

BACKGROUND/AIMS: Infliximab has been proven to be effective for refractory luminal and fistulizing Crohn's disease (CD). We performed this study to demonstrate the efficacy of infliximab in Korean CD patients. METHODS: Medical records of 40 CD patients who had been treated with infliximab were reviewed retrospectively. RESULTS: Among 40 patients, 11 (27.5%) patients were treated for refractory luminal disease, 14 (35%) for fistulizing disease, and 15 (37.5%) for both types. Clinical response rate was higher in 26 patients with refractory luminal disease (Complete response (CR), 73.1%; Partial response (PR), 23.1%) than in 29 patients with fistulizing disease (CR, 41.4%; PR, 31%) (p=0.024). The clinical response rate tended to be higher in 28 patients with external fistulas (CR, 46.4%; PR, 32.2%) than 4 patients with internal fistulas (PR, 25%; NR, 75%) (p=0.064). Among patients with external fistulas, the response rate of 8 patients with enterocutaneous fistulas (CR, 50%; PR, 12.5%) was not different from 20 patients with perianal fistulas (CR, 45%; PR, 40%). Among 20 patients with perianal fistulas, the response rate of 6 patients with perianal fistulas without a history of operation (CR, 83.3%; PR, 0%) was higher than 14 patients with perianal fistulas resistant to previous surgical treatment (CR, 28.6%; PR, 57.1%) (p=0.044). As for adverse reaction, 7 patients experienced mild infusion reaction, and 2 patients developed serious infection. CONCLUSIONS: Infliximab is more effective for refractory luminal disease than for fistulizing disease. In addition, clinical responses to infliximab are different according to subtypes of fistulas. These findings should be considered for the proper use of infliximab.
Adolescent ; Adult ; Antibodies, Monoclonal/*therapeutic use ; Asian Continental Ancestry Group ; Crohn Disease/*drug therapy ; Female ; Fistula/*drug therapy ; Humans ; Immunosuppressive Agents/*therapeutic use ; Korea ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

Dermatomyositis (DM) is an inflammatory myopathy of unknown etiology, which involves predominantly the muscles and skin, but also produces pulmonary manifestations in approximately 10% of the patients. Increasing attention has been paid to progressive interstitial pneumonitis as an important pulmonary manifestation of DM that can sometimes have a serious influence on the prognosis. Pneumomediastinum has been reported as a rare complication of DM. In this report, we present a case of 40-year-old woman with DM and interstitial lung disease who developed spontaneuous pneumomediastinum and was successfully treated with cyclosporin A.
Adult ; Cyclosporine* ; Dermatomyositis* ; Female ; Humans ; Lung Diseases, Interstitial ; Mediastinal Emphysema* ; Muscles ; Myositis ; Prognosis ; Skin