Pro-myelocytic acute leukemia (APL) is characterized by the proliferation of cells blocked at promyelocytic stage and ATRA is the choice of initial treatment because of the APL sensitivity to this compound. In this case study we report a 28-year-old man who presented to the Emergency Department with epistaxis, petechial rash, and fever. Laboratory tests revealed the presence of high white blood cell count with 60% blasts and evidence of coagulopathy. The diagnosis was confirmed later as APL. Because of the delayed transfer to the reference center and unavailability of ATRA initial treatment, the patient received isotretinoin, a related compound. The treatment was successfully implemented in the initial management of acute pro-myelocytic leukemia as patient condition improved. isotretinoin could be used as an alternative therapy for ATRA whenever the latter is not available. further research is needed to establish the appropriate doses and to assess the potential risk of differentiation syndromes.