Yanamandra Uday, Sahu Kamal Kant, Khadwal Alka, Prakash Gaurav, Varma Subhash Chander, Malhotra Pankaj
Department of Clinical Haematology, Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India.
Indian J Hematol Blood Transfus. 2016 Jun;32(Suppl 1):41-5. doi: 10.1007/s12288-015-0587-1. Epub 2015 Sep 8.
We present a patient of acute promyelocytic leukaemia managed with all-trans-retinoic-acid and arsenic trioxide who developed hypercalcemia with target organ damage. The patient also was simultaneously discovered to be symptomatic from hyperparathyroidism, which was unmasked after ATRA administration. Patient was successfully managed without any interruption of ATRA therapy and parathyroidectomy. We discuss the mechanisms of ATRA in causing hypercalcemia and its possible role in index case in unmasking hyperparathyroidism. Present case refutes Occam's razor and emphasise that known adverse effects shouldn't withhold clinicians from working up for other common causes for a given condition.
我们报告了一名急性早幼粒细胞白血病患者，该患者接受全反式维甲酸和三氧化二砷治疗，出现了伴有靶器官损害的高钙血症。同时发现该患者因甲状旁腺功能亢进出现症状，在给予全反式维甲酸后得以显露。患者在全反式维甲酸治疗和甲状旁腺切除术未中断的情况下成功得到治疗。我们讨论了全反式维甲酸导致高钙血症的机制及其在该病例中揭示甲状旁腺功能亢进的可能作用。本病例反驳了奥卡姆剃刀原理，并强调已知的不良反应不应阻止临床医生对特定病症的其他常见病因进行检查。
