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Myocarditis Concurrent with Sweet Syndrome: A Presentation of Acute Myeloid Leukemia. Case Rep Hematol 2021; 2021:6621007. [PMID: 34055428 PMCID: PMC8133866 DOI: 10.1155/2021/6621007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/23/2021] [Accepted: 04/30/2021] [Indexed: 11/29/2022] Open
Abstract
Acute myeloid leukemia (AML) is the most common acute leukemia in American adults and portends a poor prognosis if untreated. Commonly, AML presents with symptoms related to concurrent leukopenia, anemia, or thrombocytopenia; however, due to its ability to affect many organ systems in the body, AML can have a highly varied clinical presentation. One such presentation is myocarditis, which is a rarely reported manifestation of AML. Myocarditis can have a varied clinical picture and often requires exclusion of other causes of cardiac dysfunction. Sweet syndrome, also known as acute febrile neutrophilic dermatosis, is another presentation of AML; however, it is more commonly associated with AML than cardiac involvement. Sweet syndrome can occur in patients with an already established malignancy or can occur de novo in a patient with previously undiagnosed cancer and, interestingly, can also be accompanied by extracutaneous manifestations, one of which is myocarditis. Herein, we report a case of a 45-year-old male with a history of obesity and depression who presented with chest pain, a tender and diffuse rash, and pancytopenia. Heart catheterization performed at outside institution was negative for coronary artery disease. Cardiac MRI images were compatible with myocarditis. Dermal biopsy of the rash was consistent with sweet syndrome. Peripheral blood flow cytometry and bone marrow biopsy confirmed the diagnosis of AML. He was treated with an induction chemotherapy regimen of 7 days of cytarabine and 3 days of daunorubicin with resolution of his chest pain and skin lesions. The patient had persistent leukemia cells on day 14 postinduction bone marrow biopsy and was treated with high-dose cytarabine reinduction treatment. Bone marrow biopsy with count recovery after reinduction therapy revealed complete response (CR).
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Bucchia M, Barbarot S, Reumaux H, Piram M, Mahe E, Mallet S, Balguerie X, Phan A, Lacour JP, Decramer S, Hatchuel Y, Jean S, Begon E, Joubert A, Merlin E, Wallach D, Meinzer U, Bourrat E. Age-specific characteristics of neutrophilic dermatoses and neutrophilic diseases in children. J Eur Acad Dermatol Venereol 2019; 33:2179-2187. [PMID: 31166045 DOI: 10.1111/jdv.15730] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 05/08/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Our suggested 'modern' concepts of 'neutrophilic dermatoses' (ND) and 'neutrophilic disease' were based on observations in adult patients and have not been studied in paediatric patients. Only a minority of ND occurs in children, and little is known about age-specific characteristics. OBJECTIVES To describe age-specific characteristics of ND in children and to study whether our suggested 'modern' classification of ND may be applied to children. METHODS We conducted a retrospective multicentre study in a French cohort of 27 paediatric patients diagnosed with pyoderma gangrenosum (PG) or Sweet's syndrome (SS). RESULTS Demographics and distribution of typical/atypical forms were similar in patients diagnosed with PG and SS. Atypical ND were more frequent in infants (90%), when compared to young children (60%) and adolescents (33%). Neutrophilic disease was observed in 17/27 patients and was most frequent in infants. Neutrophilic disease of the upper respiratory tract, as well as cardiac neutrophilic disease, was only observed in infants, whereas other locations were similarly found in infants, young children and adolescents. In infants and young children, ND were associated with a large spectrum of general diseases, whereas in adolescents associations were limited to inflammatory bowel disease and Behçet's disease. CONCLUSIONS Our study describes the concept of ND in paediatric patients and shows that they have some characteristics different from ND occurring in adults. ND occurring in infants can be associated with a large spectrum of general diseases. Occurrence of neutrophilic disease is frequent in children. Thus, ND occurring in young paediatric patients should incite clinicians to schedule complementary explorations in order to search for involvement of other organs and to rule out monogenetic autoinflammatory syndromes.
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Affiliation(s)
- M Bucchia
- Centre Hospitalier Le Mans, Service Urgences pédiatriques, Le Mans, France.,Centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l'enfant (RAISE), Service de pédiatrie générale, Maladies Infectieuses et Médecine Interne, Hôpital Robert Debré, Paris, France
| | - S Barbarot
- Service de Dermatologie, CHU de Nantes - Hôtel Dieu, Nantes, France
| | - H Reumaux
- Service de Pédiatrie et médecine générale, CHRU de Lille, Hôpital Jeanne de Flandre, Lille, France
| | - M Piram
- CHU de Bicêtre, Service de Rhumatologue Pédiatrique, CEREMAIA, Le Kremlin-Bicêtre, France.,CESP, U1018 Inserm, Université Paris-Sud, Le Kremlin-Bicêtre, France
| | - E Mahe
- Service de Dermatologie, Unité de Soutien à la Recherche Clinique, Argenteuil, France
| | - S Mallet
- Service de Dermatologie de l'hôpital de la Timone, Aix-Marseille Université, Marseille, France
| | - X Balguerie
- Clinique Dermatologique, CHU de Rouen, Rouen, France
| | - A Phan
- Service de Néphro-Rhumato-Dermatologie Pédiatrique, Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Bron, France
| | - J-P Lacour
- Service de Dermatologie, Centre Hospitalier Universitaire de Nice, Nice, France
| | - S Decramer
- Centre Hospitalier Universitaire de Toulouse, Service de Néphrologie Médecine Interne Pédiatrique, Hôpital des Enfants, Centre De Référence des Maladies Rénales Rares du Sud Ouest, Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Y Hatchuel
- Service de Pédiatrie, Centre Hospitalier Universitaire de Martinique, Fort de France, France
| | - S Jean
- Service de pédiatrie Centre Hospitalier universitaire de Rennes, Rennes, France
| | - E Begon
- Service de Médecine, Centre Hospitalier René-Dubois, Cergy Pontoise, France
| | - A Joubert
- Service de Dermatologie, CHU de Nantes - Hôtel Dieu, Nantes, France
| | - E Merlin
- CHU Clermont-Ferrand, Pédiatrie Générale Multidisciplinaire, CIC INSERM 1405, Clermont-Ferrand, France
| | - D Wallach
- Médecin (honoraire) des Hôpitaux de Paris, Paris, France
| | - U Meinzer
- Centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l'enfant (RAISE), Service de pédiatrie générale, Maladies Infectieuses et Médecine Interne, Hôpital Robert Debré, Paris, France.,INSERM UMR1149, Université Paris Diderot, Paris, France.,Institut Pasteur, Unité Biologie et génétique de la paroi bactérienne, Paris, France
| | - E Bourrat
- Centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l'enfant (RAISE), Service de pédiatrie générale, Maladies Infectieuses et Médecine Interne, Hôpital Robert Debré, Paris, France.,Service de Dermatologie, Centre Hospitalier Universitaire Saint-Louis, Paris, France
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Clonal neutrophil infiltrates in concurrent Sweet's syndrome and acute myeloid leukemia: A case report and literature review. Cancer Genet 2018; 226-227:11-16. [PMID: 30005849 DOI: 10.1016/j.cancergen.2018.04.120] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/09/2018] [Accepted: 04/27/2018] [Indexed: 01/01/2023]
Abstract
Sweet's syndrome (SS), also known as acute febrile neutrophilic dermatosis is often associated with a hematological malignancy, especially acute myeloid leukemia (AML) and myeloid dysplasia syndrome. Histopathologically, SS is characterized by diffuse infiltrates in the upper dermis, predominantly consisting of mature neutrophils. The origin of neutrophils invading the skin remains unknown. Herein, we report a patient with concurrent acute monoblastic leukemia and SS who initially presented with discrete erythematous papules and nodules on the neck. Single nucleotide polymorphism (SNP) array and next generation sequencing (NGS) revealed a concordant fms-related tyrosine kinase-3 (FLT-3) gene mutation in the bone marrow and skin lesion, indicating that the neutrophilic infiltrates were clonally related to the underlying myeloid neoplasm. This is the first case report of concurrent SS and AML, in which SNP array and NGS analysis were applied to confirm the clonality of the neutrophilic infiltrates.
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Yu WYH, Manrriquez E, Bhutani T, Chaganti RK, Ruben BS, Schwartz BS, Fox LP. Sweet heart: A case of pregnancy-associated acute febrile neutrophilic dermatosis with myopericarditis. JAAD Case Rep 2014; 1:12-4. [PMID: 27075127 PMCID: PMC4802522 DOI: 10.1016/j.jdcr.2014.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
| | - Erica Manrriquez
- School of Medicine, University of California, San Francisco, California
| | - Tina Bhutani
- Department of Dermatology, University of California, San Francisco, California
| | - R Krishna Chaganti
- Division of Rheumatology, University of California, San Francisco, California
| | - Beth S Ruben
- Department of Dermatology, University of California, San Francisco, California; Department of Pathology, University of California, San Francisco, California
| | - Brian S Schwartz
- Division of Infectious Diseases, University of California, San Francisco, California
| | - Lindy P Fox
- Department of Dermatology, University of California, San Francisco, California
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Li Y, Ai M, Yang WB, Li X. Vital organ involvement in Sweet's syndrome with myelodysplastic syndrome: a case report and literature review. Int J Dermatol 2014; 54:1303-8. [PMID: 24697510 DOI: 10.1111/ijd.12280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 02/21/2013] [Accepted: 03/17/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Yun Li
- Department of Dermatology; 181st Hospital of the Chinese People's Liberation Army; Guilin China
| | - Mi Ai
- Department of Dermatology; 181st Hospital of the Chinese People's Liberation Army; Guilin China
| | - Wei-bing Yang
- Department of Dermatology; 181st Hospital of the Chinese People's Liberation Army; Guilin China
| | - Xin Li
- Department of Dermatology; 181st Hospital of the Chinese People's Liberation Army; Guilin China
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Prat L, Bouaziz JD, Wallach D, Vignon-Pennamen MD, Bagot M. Neutrophilic dermatoses as systemic diseases. Clin Dermatol 2013; 32:376-88. [PMID: 24767185 DOI: 10.1016/j.clindermatol.2013.11.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Neutrophilic dermatoses (ND) are inflammatory skin conditions characterized by a sterile infiltrate of normal polymorphonuclear leukocytes. The main clinical forms of ND include Sweet syndrome, pyoderma gangrenosum, erythema elevatum diutinum, subcorneal pustular dermatosis, and their atypical or transitional forms. ND are often idiopathic, but they may be associated with myeloid hematologic malignancies (Sweet syndrome), inflammatory bowel disease or rheumatoid arthritis (pyoderma gangrenosum), and monoclonal gammopathies (erythema elevatum diutinum, subcorneal pustular dermatosis). The possible infiltration of internal organs with neutrophils during the setting of ND underlies the concept of a neutrophilic systemic disease. ND may be seen as a polygenic autoinflammatory syndrome due to their frequent association with other autoinflammatory disorders (monogenic or polygenic) and the recent published efficacy of interleukin-1 blocking therapies in their management.
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Affiliation(s)
- Lola Prat
- Université Paris Diderot, Sorbonne Paris Cité; AP-HP, Paris, France; Service de Dermatologie et Service d'Anatomo-Pathologie, Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - Jean-David Bouaziz
- Université Paris Diderot, Sorbonne Paris Cité; AP-HP, Paris, France; Service de Dermatologie et Service d'Anatomo-Pathologie, Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France.
| | - Daniel Wallach
- Université Paris Diderot, Sorbonne Paris Cité; AP-HP, Paris, France; Service de Dermatologie et Service d'Anatomo-Pathologie, Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - Marie-Dominique Vignon-Pennamen
- Université Paris Diderot, Sorbonne Paris Cité; AP-HP, Paris, France; Service de Dermatologie et Service d'Anatomo-Pathologie, Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - Martine Bagot
- Université Paris Diderot, Sorbonne Paris Cité; AP-HP, Paris, France; Service de Dermatologie et Service d'Anatomo-Pathologie, Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France
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Kroshinsky D, Alloo A, Rothschild B, Cummins J, Tan J, Montecino R, Hoang MP, Duncan L, Mihm M, Sepehr A. Necrotizing Sweet syndrome: a new variant of neutrophilic dermatosis mimicking necrotizing fasciitis. J Am Acad Dermatol 2012; 67:945-54. [PMID: 22445215 DOI: 10.1016/j.jaad.2012.02.024] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Revised: 02/15/2012] [Accepted: 02/17/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND We report a series of patients initially given the diagnosis of necrotizing fasciitis whose course progressed despite surgical debridement, antibiotic therapy, or both, but who responded rapidly to systemic corticosteroids. OBJECTIVE We sought to evaluate the clinical data, histopathologic and microbiology information, and treatment course of this unusual entity. METHODS This was a descriptive study/case series. RESULTS Three immunocompromised patients who presented with signs and symptoms of necrotizing fasciitis were included. They appeared septic, failed multiple courses of antibiotics, demonstrated pathergy, and two of them underwent extensive surgical debridement. None of the cases yielded a microbial source. Dermatologic consultation and histopathology confirmed deep Sweet syndrome in all cases, with marked necrosis of the soft tissue--including myonecrosis--in the two patients with debridement. All patients responded rapidly to high-dose systemic corticosteroids. LIMITATIONS To our knowledge, this is the first report of this unusual presentation; there are a limited number of cases. CONCLUSION We propose that these cases represent a new variant of neutrophilic dermatosis: "necrotizing Sweet syndrome," an acute necrotizing neutrophilic dermatosis. This subtype is also characterized by the rapid onset of progressive erythematous, warm, edematous cutaneous lesions with deep-tissue neutrophilic infiltration and soft-tissue necrosis, in the absence of infectious cause. Awareness of this entity and early dermatologic consultation is critical as debridement results in expansion of the process, resulting in additional and aggressive resection--a vicious cycle with significant possible morbidity.
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Affiliation(s)
- Daniela Kroshinsky
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Turow A, Yong TY, Fok JS, Li JYZ. Azathioprine hypersensitivity presenting as cardiogenic shock and Sweet's syndrome in a patient with microscopic polyangiitis. Intern Med 2012; 51:1889-92. [PMID: 22821107 DOI: 10.2169/internalmedicine.51.6962] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Azathioprine hypersensitivity is a clinical syndrome which may manifest from isolated fever and rash to multi-organ failure. This rare condition is usually self-limiting following the discontinuation of azathioprine. Therefore, it is important to maintain a high index of clinical suspicion for hypersensitivity reactions with azathioprine therapy. We report a case of azathioprine hypersensitivity in a 69-year-old woman who developed cardiogenic shock and Sweet's syndrome following the initiation of azathioprine for her underlying autoantibodies to neutrophil cytoplasmic antigens (ANCA) associated microscopic polyangiitis.
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Affiliation(s)
- Arthur Turow
- Department of General Medicine, Flinders Medical Centre, Australia
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Dabade TS, Davis MDP. Diagnosis and treatment of the neutrophilic dermatoses (pyoderma gangrenosum, Sweet's syndrome). Dermatol Ther 2011; 24:273-84. [DOI: 10.1111/j.1529-8019.2011.01403.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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10
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The relationship between acute coronary syndrome and inflammation: a case of acute myocardial infarction associated with coronary involvement of Sweet's syndrome. Blood Coagul Fibrinolysis 2011; 21:703-6. [PMID: 20729720 DOI: 10.1097/mbc.0b013e32833e4781] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Sweet's syndrome is characterized by skin lesions and fever. One of the rare extracutaneous manifestations of Sweet's syndrome is cardiovascular involvement including coronary artery occlusion. In this article, we present a case of acute myocardial infarction associated with exacerbation of Sweet's syndrome. Coronary angiography has demonstrated normal left coronary arterial system and the occlusion of distal right coronary artery. The patient underwent successful balloon angioplasty and subsequent coronary artery stenting. The presence of coronary ectasia, aneurysm and coronary occlusion of right coronary artery caused us to hypothesize that the coronary involvement including ectasia, aneurysm and occlusion might be associated with hyperreactive inflammatory response secondary to exacerbations of Sweet's syndrome.
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A Case of Sweet Syndrome with Spleen and Lymph Node Involvement Preceded by Parvovirus B19 infection, and a Review of the Literature on Extracutaneous Sweet Syndrome. Am J Dermatopathol 2010; 32:621-7. [PMID: 20534986 DOI: 10.1097/dad.0b013e3181ce5933] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Johnson CS, May ER, Myers RK, Hostetter JM. Extracutaneous neutrophilic inflammation in a dog with lesions resembling Sweet's Syndrome. Vet Dermatol 2009; 20:200-5. [DOI: 10.1111/j.1365-3164.2009.00746.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cohen PR. Sweet's syndrome--a comprehensive review of an acute febrile neutrophilic dermatosis. Orphanet J Rare Dis 2007; 2:34. [PMID: 17655751 PMCID: PMC1963326 DOI: 10.1186/1750-1172-2-34] [Citation(s) in RCA: 490] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2007] [Accepted: 07/26/2007] [Indexed: 01/19/2023] Open
Abstract
Sweet's syndrome (the eponym for acute febrile neutrophilic dermatosis) is characterized by a constellation of clinical symptoms, physical features, and pathologic findings which include fever, neutrophilia, tender erythematous skin lesions (papules, nodules, and plaques), and a diffuse infiltrate consisting predominantly of mature neutrophils that are typically located in the upper dermis. Several hundreds cases of Sweet's syndrome have been published. Sweet's syndrome presents in three clinical settings: classical (or idiopathic), malignancy-associated, and drug-induced. Classical Sweet's syndrome (CSS) usually presents in women between the age of 30 to 50 years, it is often preceded by an upper respiratory tract infection and may be associated with inflammatory bowel disease and pregnancy. Approximately one-third of patients with CSS experience recurrence of the dermatosis. The malignancy-associated Sweet's syndrome (MASS) can occur as a paraneoplastic syndrome in patients with an established cancer or individuals whose Sweet's syndrome-related hematologic dyscrasia or solid tumor was previously undiscovered; MASS is most commonly related to acute myelogenous leukemia. The dermatosis can precede, follow, or appear concurrent with the diagnosis of the patient's cancer. Hence, MASS can be the cutaneous harbinger of either an undiagnosed visceral malignancy in a previously cancer-free individual or an unsuspected cancer recurrence in an oncology patient. Drug-induced Sweet's syndrome (DISS) most commonly occurs in patients who have been treated with granulocyte-colony stimulating factor, however, other medications may also be associated with DISS. The pathogenesis of Sweet's syndrome may be multifactorial and still remains to be definitively established. Clinical and laboratory evidence suggests that cytokines have an etiologic role. Systemic corticosteroids are the therapeutic gold standard for Sweet's syndrome. After initiation of treatment with systemic corticosteroids, there is a prompt response consisting of dramatic improvement of both the dermatosis-related symptoms and skin lesions. Topical application of high potency corticosteroids or intralesional corticosteroids may be efficacious for treating localized lesions. Other first-line oral systemic agents are potassium iodide and colchicine. Second-line oral systemic agents include indomethacin, clofazimine, cyclosporine, and dapsone. The symptoms and lesions of Sweet's syndrome may resolved spontaneously, without any therapeutic intervention; however, recurrence may follow either spontaneous remission or therapy-induced clinical resolution.
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Affiliation(s)
- Philip R Cohen
- University of Houston Health Center, Houston, Texas, USA.
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Stos B, Hatchuel Y, Bonnet D. Mitral valvar regurgitation in a child with Sweet's syndrome. Cardiol Young 2007; 17:218-9. [PMID: 17184566 DOI: 10.1017/s1047951106001363] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2006] [Indexed: 11/06/2022]
Abstract
We report the very unusual perforation of the mitral valve in the setting of Sweet's syndrome, or acute febrile neutrophilic dermatosis, in a boy aged 5 years. Surgical repair was uneventful, and follow-up showed no residual anomalies. Acute or delayed valvitis, with damage to either the mitral or aortic valves, should be screened for in this rare disease.
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Affiliation(s)
- Bertrand Stos
- Pediatric Cardiology, University Paris V-Descartes, Necker, AP-HP, Paris, France.
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Abstract
Sweet's syndrome, also referred to as acute febrile neutrophilic dermatosis, is characterized by a constellation of symptoms and findings: fever, neutrophilia, erythematous and tender skin lesions that typically show an upper dermal infiltrate of mature neutrophils, and prompt improvement of both symptoms and lesions after the initiation of treatment with systemic corticosteroids. Hundreds of patients with this dermatosis have been reported. The manifestations of Sweet's syndrome in these individuals have not only confirmed those originally described by Dr Robert Douglas Sweet in 1964, but have also introduced new features that have expanded the clinical and pathologic concepts of this condition. The history, clinical characteristics, laboratory findings, associated diseases, pathology, and treatment options of Sweet's syndrome are reviewed. The evolving and new concepts of this dermatosis that are discussed include: (i) Sweet's syndrome occurring in the clinical setting of a disease-related malignancy, or medication, or both; (ii) detection of additional sites of extracutaneous Sweet's syndrome manifestations; (iii) discovery of additional Sweet's syndrome-associated diseases; (iv) variability of the composition and/or location of the cutaneous inflammatory infiltrate in Sweet's syndrome lesions; and (v) additional efficacious treatments for Sweet's syndrome.
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Affiliation(s)
- Philip R Cohen
- University of Houston Health Center, Department of Dermatology, The University of Texas-Houston Medical School, Houston, Texas, USA.
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Affiliation(s)
- Marc Dorenkamp
- Department of Cardiology and Pneumology, Benjamin Franklin University Hospital, 12200, Berlin, German
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Turesin F, Sadr A, Davison JS, Mathison R. The tripeptide FEG ameliorates systemic inflammatory responses to rat intestinal anaphylaxis. BMC PHYSIOLOGY 2002; 2:13. [PMID: 12199907 PMCID: PMC126222 DOI: 10.1186/1472-6793-2-13] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2002] [Accepted: 08/19/2002] [Indexed: 11/25/2022]
Abstract
BACKGROUND Food allergies are generally associated with gastrointestinal upset, but in many patients systemic reactions occur. However, the systemic effects of food allergies are poorly understood in experimental animals, which also offer the opportunity to explore the actions of anti-allergic drugs. The tripeptide D-phenylalanine-D-glutamate-Glycine (feG), which potentially alleviates the symptoms of systemic anaphylactic reactions, was tested to determine if it also reduced systemic inflammatory responses provoked by a gastric allergic reaction. RESULTS Optimal inhibition of intestinal anaphylaxis was obtained when 100 microg/kg of feG was given 20 min before the rats were challenged with antigen. The increase in total circulating neutrophils and accumulation of neutrophils in the heart, developing 3 h and 24 h, respectively, after antigen challenge were reduced by both feG and dexamethasone. Both anti-inflammatory agents reduced the increase in vascular permeability induced by antigen in the intestine and the peripheral skin (pinna), albeit with different time courses. Dexamethasone prevented increases in vascular permeability when given 12 h before antigen challenge, whereas feG was effective when given 20 min before ingestion of antigen. The tripeptide prevented the anaphylaxis induced up regulation of specific antibody binding of a cell adhesion molecule related to neutrophil activation, namely CD49d (alpha4 integrin). CONCLUSIONS Aside from showing that intestinal anaphylaxis produces significant systemic inflammatory responses in non-intestinal tissues, our results indicate that the tripeptide feG is a potent inhibitor of extra-gastrointestinal allergic reactions preventing both acute (30 min) and chronic (3 h or greater) inflammatory responses.
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Affiliation(s)
- Fusun Turesin
- Faculty of Medicine, Department of Physiology and Biophysics, University of Calgary, Calgary, Alberta T2N 4N1, USA
| | - Aida Sadr
- Faculty of Medicine, Department of Physiology and Biophysics, University of Calgary, Calgary, Alberta T2N 4N1, USA
| | - Joseph S Davison
- Faculty of Medicine, Department of Physiology and Biophysics, University of Calgary, Calgary, Alberta T2N 4N1, USA
| | - Ronald Mathison
- Faculty of Medicine, Department of Physiology and Biophysics, University of Calgary, Calgary, Alberta T2N 4N1, USA
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Ishiguro A, Ishiguro Y, Uno Y, Yamagata K, Sakuraba H, Munakata A. Colonic infiltration associated with myelodysplastic syndrome. Gastrointest Endosc 2001; 54:517-9. [PMID: 11577323 DOI: 10.1067/mge.2001.116570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- A Ishiguro
- First Department of Internal Medicine, Hirosaki University School of Medicine, 5 Zaifu-cyo, Hirosaki, 036-89216, Japan
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Affiliation(s)
- C D Hensley
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia 30322, USA
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Cohen PR, Kurzrock R. Sweet's syndrome: a neutrophilic dermatosis classically associated with acute onset and fever. Clin Dermatol 2000; 18:265-82. [PMID: 10856659 DOI: 10.1016/s0738-081x(99)00129-7] [Citation(s) in RCA: 116] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- P R Cohen
- Department of Dermatology, The University of Texas-Houston Medical School, Houston, Texas, USA
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