Leukemia cutis and all-trans retinoic acid-induced myocarditis in acute promyelocytic leukemia

Acute promyelocytic leukemia (APL) is frequently curable in the modern era using the chemotherapy-free regimen of all-trans retinoic acid (ATRA) and arsenic trioxide (ATO). However, rare disease manifestations and treatment complications may threaten these outcomes by requiring intensification or abbreviation of therapy. We present a unique case of a 36-year-old male with newly diagnosed low-risk APL with biopsy-confirmed leukemia cutis and isolated ATRA-associated myocarditis during induction therapy. Both APL leukemia cutis and ATRA-associated myocarditis are exceedingly rare, with each having less than 50 published cases to date. This report offers a comprehensive review of the literature, underscoring the importance of a comprehensive diagnostic evaluation and individualized care to ensure outstanding long-term outcomes for patients with APL.