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Acute promyelocytic leukemia (APL), more common in young and middle-aged people, is a unique subtype of acute myeloid leukemia. Recently, the experience in the treatment of elderly APL is limited. This report described the first case of APL in a patient older than 90 years in China. With the stealthy onset and no typical symptoms, the diagnosis was made timely based on close detection of laboratory examination. After a comprehensive evaluation of the patient's condition, the patient received half-dose arsenic trioxide (ATO) alone. The patient tolerated this dose well and achieved molecular complete remission. This report also provides clinical experience for the treatment of elderly APL.