Abstract：
BACKGROUND: Acute promyelocytic leukemia (APL) is the most malignant form of acute myeloid leukemia (AML) with short survival without treatment. All trans retinoic acid (ATRA) is a vitamin A metabolite and plays an important role in the treatment of APL. Hypercalcemia is a rare side effect of ATRA.
METHODS: A 67-year-old female patient was investigated due to widespread bruising and pancytopenia. The patient was diagnosed with APL and remission was achieved by administering idarubicin together with ATRA in the induction treatment. The patient has hypocalcemia due to acquired hypoparathyroidism, and it was observed that the calcium level increased with the initiation of fluconazole 200 mg/day for antifungal prophylaxis together with ATRA in the consolidation treatment. It was observed that the calcium value reached 13 mg/dL by increasing the fluconazole to 400 mg/day treatment dose due to oral mucositis.
METHODS: The development of hypercalcemia has been reported in previous case reports when ATRA is used together with voriconazole, fosfluconazole, itraconazole, and posaconazole, which inhibit cytochrome P450 enzymes. In this case, it is the first in the literature that a patient with hypocalcemia due to acquired hypoparathyroidism developed hypercalcemia after fluconazole and ATRA were used together.
CONCLUSIONS: Since hypercalcemia may develop while azole drugs are administered during ATRA treatment, it is important to monitor calcium levels to prevent complications of hypercalcemia.
METHODS: A 67-year-old female patient was investigated due to widespread bruising and pancytopenia. The patient was diagnosed with APL and remission was achieved by administering idarubicin together with ATRA in the induction treatment. The patient has hypocalcemia due to acquired hypoparathyroidism, and it was observed that the calcium level increased with the initiation of fluconazole 200 mg/day for antifungal prophylaxis together with ATRA in the consolidation treatment. It was observed that the calcium value reached 13 mg/dL by increasing the fluconazole to 400 mg/day treatment dose due to oral mucositis.
METHODS: The development of hypercalcemia has been reported in previous case reports when ATRA is used together with voriconazole, fosfluconazole, itraconazole, and posaconazole, which inhibit cytochrome P450 enzymes. In this case, it is the first in the literature that a patient with hypocalcemia due to acquired hypoparathyroidism developed hypercalcemia after fluconazole and ATRA were used together.
CONCLUSIONS: Since hypercalcemia may develop while azole drugs are administered during ATRA treatment, it is important to monitor calcium levels to prevent complications of hypercalcemia.
摘要：
背景：急性早幼粒细胞白血病（APL）是急性髓性白血病（AML）的最恶性形式，不治疗生存期短。全反式维甲酸（ATRA）是一种维生素A代谢产物，在APL的治疗中起着重要作用。高钙血症是ATRA的罕见副作用。
方法：对一名67岁女性患者进行调查，原因是广泛的瘀伤和全血细胞减少症。患者被诊断为患有APL，并通过在诱导治疗中与ATRA一起施用伊达比星来实现缓解。患者因获得性甲状旁腺功能减退而出现低钙血症,并且观察到钙水平随着开始使用氟康唑200mg/天用于抗真菌预防以及在巩固治疗中与ATRA一起增加。观察到,由于口腔粘膜炎,通过将氟康唑增加至400mg/天的治疗剂量,钙值达到13mg/dL。
方法：在以前的病例报告中已经报道了当ATRA与伏立康唑一起使用时，高钙血症的发展。氟康唑,伊曲康唑,和泊沙康唑,抑制细胞色素P450酶。在这种情况下,在文献中首次出现因获得性甲状旁腺功能减退症导致的低钙血症患者在联合使用氟康唑和ATRA后出现高钙血症.
结论：由于在ATRA治疗期间服用唑类药物可能会出现高钙血症，监测钙水平对预防高钙血症并发症很重要.
方法：对一名67岁女性患者进行调查，原因是广泛的瘀伤和全血细胞减少症。患者被诊断为患有APL，并通过在诱导治疗中与ATRA一起施用伊达比星来实现缓解。患者因获得性甲状旁腺功能减退而出现低钙血症,并且观察到钙水平随着开始使用氟康唑200mg/天用于抗真菌预防以及在巩固治疗中与ATRA一起增加。观察到,由于口腔粘膜炎,通过将氟康唑增加至400mg/天的治疗剂量,钙值达到13mg/dL。
方法：在以前的病例报告中已经报道了当ATRA与伏立康唑一起使用时，高钙血症的发展。氟康唑,伊曲康唑,和泊沙康唑,抑制细胞色素P450酶。在这种情况下,在文献中首次出现因获得性甲状旁腺功能减退症导致的低钙血症患者在联合使用氟康唑和ATRA后出现高钙血症.
结论：由于在ATRA治疗期间服用唑类药物可能会出现高钙血症，监测钙水平对预防高钙血症并发症很重要.
