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Alzahrani F, Tolson H, Dupuy E, Price H. Paediatric Sweet's syndrome with pulmonary involvement triggered by severe inflammatory bowel disease and emergent total abdominal colectomy with literature review. SKIN HEALTH AND DISEASE 2024; 4:e326. [PMID: 38577048 PMCID: PMC10988687 DOI: 10.1002/ski2.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/15/2023] [Accepted: 12/06/2023] [Indexed: 04/06/2024]
Abstract
Sweet's syndrome (SS) is a neutrophilic dermatosis characterised by the acute onset of erythematous papules or plaques and a constellation of symptoms including fever, leucocytosis, and histopathology demonstrating nodular, pustular, or diffuse infiltrate of neutrophils with marked papillary oedema. SS can be a manifestation of inflammatory bowel disease and often coincides with periods of disease flares. Only a few cases of SS associated with ulcerative colitis are reported in the literature, and no cases have involved pulmonary manifestations in the paediatric population. We present a case of a 14-year-old girl presenting with new onset ulcerative colitis requiring emergent colectomy with subsequent development of pulmonary SS. Treatment consisted of intravenous and oral corticosteroids and dapsone. SS should be considered in the differential diagnosis of prolonged fever with cutaneous involvement and systemic symptoms. Special consideration should be given to paediatric patients with extracutaneous manifestations, particularly pulmonary involvement.
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Affiliation(s)
- Fatmah Alzahrani
- Division of DermatologyPhoenix Children's HospitalPhoenixArizonaUSA
- Mayo Clinic College of Medicine and SciencePhoenixArizonaUSA
| | - Hannah Tolson
- Department of Child HealthUniversity of Arizona College of MedicinePhoenixArizonaUSA
| | - Elizabeth Dupuy
- Division of DermatologyPhoenix Children's HospitalPhoenixArizonaUSA
- Mayo Clinic College of Medicine and SciencePhoenixArizonaUSA
| | - Harper Price
- Division of DermatologyPhoenix Children's HospitalPhoenixArizonaUSA
- Mayo Clinic College of Medicine and SciencePhoenixArizonaUSA
- Department of Child HealthUniversity of Arizona College of MedicinePhoenixArizonaUSA
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Fiesco-Roa MÓ, García-de Teresa B, Leal-Anaya P, van ‘t Hek R, Wegman-Ostrosky T, Frías S, Rodríguez A. Fanconi anemia and dyskeratosis congenita/telomere biology disorders: Two inherited bone marrow failure syndromes with genomic instability. Front Oncol 2022; 12:949435. [PMID: 36091172 PMCID: PMC9453478 DOI: 10.3389/fonc.2022.949435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Inherited bone marrow failure syndromes (IBMFS) are a complex and heterogeneous group of genetic diseases. To date, at least 13 IBMFS have been characterized. Their pathophysiology is associated with germline pathogenic variants in genes that affect hematopoiesis. A couple of these diseases also have genomic instability, Fanconi anemia due to DNA damage repair deficiency and dyskeratosis congenita/telomere biology disorders as a result of an alteration in telomere maintenance. Patients can have extramedullary manifestations, including cancer and functional or structural physical abnormalities. Furthermore, the phenotypic spectrum varies from cryptic features to patients with significantly evident manifestations. These diseases require a high index of suspicion and should be considered in any patient with abnormal hematopoiesis, even if extramedullary manifestations are not evident. This review describes the disrupted cellular processes that lead to the affected maintenance of the genome structure, contrasting the dysmorphological and oncological phenotypes of Fanconi anemia and dyskeratosis congenita/telomere biology disorders. Through a dysmorphological analysis, we describe the phenotypic features that allow to make the differential diagnosis and the early identification of patients, even before the onset of hematological or oncological manifestations. From the oncological perspective, we analyzed the spectrum and risks of cancers in patients and carriers.
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Affiliation(s)
- Moisés Ó. Fiesco-Roa
- Laboratorio de Citogenética, Instituto Nacional de Pediatría, Ciudad de México, Mexico
- Maestría y Doctorado en Ciencias Médicas, Universidad Nacional Autónoma de México (UNAM), Ciudad Universitaria, Ciudad de México, Mexico
| | | | - Paula Leal-Anaya
- Departamento de Genética Humana, Instituto Nacional de Pediatría, Ciudad de México, Mexico
| | - Renée van ‘t Hek
- Facultad de Medicina, Universidad Nacional Autoínoma de Meíxico (UNAM), Ciudad Universitaria, Ciudad de México, Mexico
| | - Talia Wegman-Ostrosky
- Subdirección de Investigación Básica, Instituto Nacional de Cancerología, Ciudad de México, Mexico
| | - Sara Frías
- Laboratorio de Citogenética, Instituto Nacional de Pediatría, Ciudad de México, Mexico
- Departamento de Medicina Genómica y Toxicología Ambiental, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, Mexico
- *Correspondence: Alfredo Rodríguez, ; Sara Frías,
| | - Alfredo Rodríguez
- Departamento de Medicina Genómica y Toxicología Ambiental, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, Mexico
- Unidad de Genética de la Nutrición, Instituto Nacional de Pediatría, Ciudad de México, Mexico
- *Correspondence: Alfredo Rodríguez, ; Sara Frías,
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Cerejeira A, Amoedo P, Coelho AR, Silva R, Pedrosa A, Nogueira A, Azevedo F. Recurrent Sweet syndrome presenting in a figurate pattern in a patient with Fanconi anemia. Int J Dermatol 2021; 61:e171-e173. [PMID: 34403507 DOI: 10.1111/ijd.15848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 05/25/2021] [Accepted: 07/23/2021] [Indexed: 12/15/2022]
Affiliation(s)
- André Cerejeira
- Department of Dermatology and Venereology, Centro Hospitalar Universitário São João, EPE Porto, Porto, Portugal
| | - Patrícia Amoedo
- Department of Dermatology and Venereology, Centro Hospitalar Universitário São João, EPE Porto, Porto, Portugal
| | - Ana Rita Coelho
- Department of Anatomic Pathology, Centro Hospitalar Universitário São João, EPE Porto, Porto, Portugal
| | - Roberto Silva
- Department of Anatomic Pathology, Centro Hospitalar Universitário São João, EPE Porto, Porto, Portugal
| | - Ana Pedrosa
- Department of Dermatology and Venereology, Centro Hospitalar Universitário São João, EPE Porto, Porto, Portugal.,Department of Medicine, Service of Dermatology and Venereology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Ana Nogueira
- Department of Dermatology and Venereology, Centro Hospitalar Universitário São João, EPE Porto, Porto, Portugal
| | - Filomena Azevedo
- Department of Dermatology and Venereology, Centro Hospitalar Universitário São João, EPE Porto, Porto, Portugal
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Webber L, Cummins M, Mann R, Shaw L, Ghinai R, Mahon C. Panniculitis in a 3-year-old child with Fanconi anemia-associated bone marrow hypoplasia heralds transformation to acute myeloid leukemia. Pediatr Dermatol 2019; 36:725-727. [PMID: 31318095 DOI: 10.1111/pde.13872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Fanconi anemia is a rare, autosomal recessive genomic instability disorder characterized by congenital limb anomalies, panmyelopathy and a high risk of malignancy, principally acute myeloid leukemia. Hematologic malignancy presenting with acute febrile neutrophilic dermatosis (Sweet syndrome), both deep and superficial forms, is well described in Fanconi anemia patients but is a rare phenomenon in otherwise healthy children. We present a case of panniculitis (presumptive subcutaneous Sweet syndrome) heralding transformation to acute myeloid leukemia in a 3-year-old boy with a severe Fanconi anemia phenotype.
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Affiliation(s)
- Lucy Webber
- Department of Paediatric Dermatology, Bristol Children's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Michelle Cummins
- Department of Paediatric Haematology & Oncology, Bristol Children's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Rebecca Mann
- Department of Paediatrics, Musgrove Park Hospital, Taunton & Somerset NHS Foundation Trust, Taunton, UK
| | - Lindsay Shaw
- Department of Paediatric Dermatology, Bristol Children's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Rosanna Ghinai
- Department of Paediatric Haematology & Oncology, Bristol Children's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Caroline Mahon
- Department of Paediatric Dermatology, Starship Child Health, Auckland, New Zealand.,Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
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Heath MS, Ortega-Loayza AG. Insights Into the Pathogenesis of Sweet's Syndrome. Front Immunol 2019; 10:414. [PMID: 30930894 PMCID: PMC6424218 DOI: 10.3389/fimmu.2019.00414] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 02/15/2019] [Indexed: 12/15/2022] Open
Abstract
Sweet's syndrome, also known as Acute Febrile Neutrophilic Dermatosis, is a rare inflammatory condition. It is considered to be the prototype disease of neutrophilic dermatoses, and presents with acute onset dermal neutrophilic lesions, leukocytosis, and pyrexia. Several variants have been described both clinically and histopathologically. Classifications include classic Sweet's syndrome, malignancy associated, and drug induced. The cellular and molecular mechanisms involved in Sweet's syndrome have been difficult to elucidate due to the large variety of conditions leading to a common clinical presentation. The exact pathogenesis of Sweet's syndrome is unclear; however, new discoveries have shed light on the role of inflammatory signaling, disease induction, and relationship with malignancy. These findings include an improved understanding of inflammasome activation, malignant transformation into dermal infiltrating neutrophils, and genetic contributions. Continued investigations into effective treatments and targeted therapy will benefit patients and improve our molecular understanding of inflammatory diseases, including Sweet's syndrome.
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Affiliation(s)
- Michael S Heath
- Oregon Health and Science University, Department of Dermatology, Portland, OR, United States
| | - Alex G Ortega-Loayza
- Oregon Health and Science University, Department of Dermatology, Portland, OR, United States
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Tzelepis E, Kampolis CF, Vlachadami I, Moschovi M, Alamani M, Kaltsas G. Cryptogenic organizing pneumonia in Sweet's syndrome: case report and review of the literature. CLINICAL RESPIRATORY JOURNAL 2014; 10:250-4. [PMID: 25196175 DOI: 10.1111/crj.12206] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 07/22/2014] [Accepted: 08/27/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Sweet's syndrome or acute febrile neutrophilic dermatosis is characterized by fever, leukocytosis and tender erythematous plaques, which show infiltration by mature neutrophils on histological examination. Pulmonary involvement is rare in Sweet's syndrome. METHOD We describe the case of a 17-year-old man with a myelodysplastic syndrome following therapy for Hodgkin's lymphoma who developed Sweet's syndrome and cryptogenic organizing pneumonia. In addition, we conducted a review of the related English literature. RESULTS Literature review yielded six similar reports of biopsy-proven cryptogenic organizing pneumonia associated with Sweet's syndrome. We present the clinical and laboratory characteristics, as well as the response to treatment, of all cases of cryptogenic organizing pneumonia reported in patients with Sweet's syndrome. CONCLUSIONS Cryptogenic organizing pneumonia is a rare manifestation of Sweet's syndrome, which may be complicated by respiratory failure. Prompt treatment with corticosteroids usually leads to clinical and radiographic improvement.
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Affiliation(s)
- Elias Tzelepis
- Department of Pathophysiology, 'Laiko' Hospital, University of Athens Medical School, Athens, Greece
| | - Christos F Kampolis
- Department of Pathophysiology, 'Laiko' Hospital, University of Athens Medical School, Athens, Greece
| | - Ioanna Vlachadami
- Department of Pathophysiology, 'Laiko' Hospital, University of Athens Medical School, Athens, Greece
| | - Maria Moschovi
- Department of Pediatrics, University of Athens Medical School, Athens, Greece
| | - Maria Alamani
- Department of Pathology, Henry Dunant Hospital, Athens, Greece
| | - Gregory Kaltsas
- Department of Pathophysiology, 'Laiko' Hospital, University of Athens Medical School, Athens, Greece
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Srisuttiyakorn C, Reeve J, Reddy S, Imaeda S, Lazova R. Subcutaneous histiocytoid Sweet's syndrome in a patient with myelodysplastic syndrome and acute myeloblastic leukemia. J Cutan Pathol 2014; 41:475-9. [DOI: 10.1111/cup.12305] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Chutika Srisuttiyakorn
- Department of Medicine, Division of Dermatology; Phramongkutklao Hospital; Bangkok Thailand
| | - Jennifer Reeve
- Department of Dermatology; Yale University School of Medicine; New Haven CT USA
| | - Swapna Reddy
- Department of Dermatology; Yale University School of Medicine; New Haven CT USA
| | - Suguru Imaeda
- Department of Dermatology; Yale University School of Medicine; New Haven CT USA
| | - Rossitza Lazova
- Department of Dermatology; Yale University School of Medicine; New Haven CT USA
- Smilow Cancer Center; New Haven CT USA
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Abstract
The objective of this study was to describe the clinical features of Sweet syndrome in children. Our study population consisted of seven children diagnosed with Sweet syndrome over a 22-year period. Age, sex, appearance and location of lesions, associated signs and symptoms, past medical history, pathology, and subsequent disease course were documented for each patient. Fever and typical lesions were reported in most of patients in our study. The majority of patients presented with less-typical findings, such as pustules, vesicles, bullae, oral ulcerations, atrophic scars, and evidence of pathergy. Of the seven children in our study, four were found to have a preceding nonspecific upper respiratory or gastrointestinal infection, and two were diagnosed with an underlying hematologic malignancy. Our results suggest that atypical lesions are relatively common in children with Sweet syndrome and that underlying malignancy is associated with a minority of cases of pediatric Sweet syndrome.
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Affiliation(s)
- Lily C Uihlein
- Harvard Combined Dermatology Residency Training Program, Boston, Massachusetts, USA
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Giulino L, Guinan EC, Gillio AP, Drachtman RA, Teruya-Feldstein J, Boulad F. Sweet syndrome in patients with Fanconi anaemia: association with extracutaneous manifestations and progression of haematological disease. Br J Haematol 2011; 154:278-81. [DOI: 10.1111/j.1365-2141.2011.08604.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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