Acute promyelocytic leukemia (APL) accounts for 5 to 20 percent of cases of AML. APL represents a medical emergency with a high rate of early mortality, often due to hemorrhage from a characteristic coagulopathy.The differentiation syndrome can occur during APL induction therapy with manifestations like fever, hypotension, dyspnea, weight gain, and musculoskeletal pain. Sometimes patient can present with atypical manifestation for which high index of suspicion and institution of preemptive steroids will be key factors in patients survival. Our case is 47 yrs old male of intermediate risk APL who had severe hypotension during APL induction treatment due to differentiation syndrome . Hypotension required inotropic support but successfully managed with steroids and temporary cessation of differentiating agents.