Deep Coma in a Patient with Promyelocytic Leukemia Treated by Arsenic Trioxide

概要

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Arsenic is a well-known heavy-metal causing acute intoxication such as nausea, vomiting, abdominal pain, severe diarrhea, polyneuropathy, and encephalopathy. Arsenic trioxide (ATO) monotherapy is effective for the relapsed or refractory acute promyelocytic leukemia (APL). ATO often causes side-effects, but most of them are tolerable with careful management. We report here a Japanese man, who was diagnosed as relapsed APL, fell into deep coma after ATO monotherapy and recovered in 24 hours. In the side-effect reports of ATO, CNS symptom is very rare. In a Japanese post-marketing surveillance study, only four cases demonstrated altered consciousness. However, these cases had other bases for CNS symptoms such as CNS infiltration, brain infarction, panic disturbance and renal failure. As no other reason for coma was detected on examination, and coma did not recur after discontinuance of ATO, ATO was suggested to cause deep coma.