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Ahangari D, Ngendahayo P, Colinet B, Roquet-Gravy PP. [A case of Sweet syndrome in a patient receiving erlotinib for lung adenocarcinoma]. Ann Dermatol Venereol 2020; 147:202-206. [PMID: 32029299 DOI: 10.1016/j.annder.2019.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 01/18/2019] [Accepted: 10/25/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Sweet syndrome is a neutrophilic dermatosis and is often idiopathic, although its onset may be drug-induced or paraneoplastic. The purpose of this case report is to describe the very first occurrence of Sweet syndrome following erlotinib intake in a patient diagnosed with lung adenocarcinoma. PATIENTS AND METHODS We observed Sweet syndrome, as assessed by clinical, laboratory and histological examination, in a middle-aged female patient presenting lung adenocarcinoma diagnosed three years prior to her cutaneous symptoms. DISCUSSION Given the extremely long time between the diagnosis of lung cancer and the onset of Sweet syndrome, as well as the occurrence of skin lesions during administration of the medication and their subsidence after drug withdrawal, we suggest a possible link between this particular EGFR tyrosine kinase inhibitor and the patient's neutrophilic dermatological signs. To our knowledge this association has not previously been described in the medical literature.
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Affiliation(s)
- D Ahangari
- Service de dermatologie, grand hôpital de Charleroi (GHDC), Charleroi, Belgique; Rue de Villers, 1, 6280 Loverval, Belgique.
| | - P Ngendahayo
- Service d'anatomopathologie, Institut de pathologie et génétique (IPG), avenue Georges-Lemaitre, 25, 6041 Charleroi, Belgique
| | - B Colinet
- Service de pneumologie, grand hôpital de Charleroi (GHDC), Grand'rue 3, 6000 Charleroi, Belgique
| | - P-P Roquet-Gravy
- Service de dermatologie, grand hôpital de Charleroi (GHDC), Charleroi, Belgique; Rue de Villers, 1, 6280 Loverval, Belgique
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Salem I, Kimak M, Conic R, Bragazzi NL, Watad A, Adawi M, Bridgewood C, Pacifico A, Santus P, Rizzi M, Petrou S, Colombo D, Fiore M, Pigatto PDM, Damiani G. Neutrophilic Dermatoses and Their Implication in Pathophysiology of Asthma and Other Respiratory Comorbidities: A Narrative Review. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7315274. [PMID: 31281845 PMCID: PMC6590566 DOI: 10.1155/2019/7315274] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 05/14/2019] [Indexed: 01/20/2023]
Abstract
Neutrophilic dermatoses (ND) are a polymorphous group of noncontagious dermatological disorders that share the common histological feature of a sterile cutaneous infiltration of mature neutrophils. Clinical manifestations can vary from nodules, pustules, and bulla to erosions and ulcerations. The etiopathogenesis of neutrophilic dermatoses has continuously evolved. Accumulating genetic, clinical, and histological evidence point to NDs being classified in the spectrum of autoinflammatory conditions. However, unlike the monogenic autoinflammatory syndromes where a clear multiple change in the inflammasome structure/function is demonstrated, NDs display several proinflammatory abnormalities, mainly driven by IL-1, IL-17, and tumor necrosis factor-alpha (TNF-a). Additionally, because of the frequent association with extracutaneous manifestations where neutrophils seem to play a crucial role, it was plausible also to consider NDs as a cutaneous presentation of a systemic neutrophilic condition. Neutrophilic dermatoses are more frequently recognized in association with respiratory disorders than by chance alone. The combination of the two, particularly in the context of their overlapping immune responses mediated primarily by neutrophils, raises the likelihood of a common neutrophilic systemic disease or an aberrant innate immunity disorder. Associated respiratory conditions can serve as a trigger or may develop or be exacerbated secondary to the uncontrolled skin disorder. Physicians should be aware of the possible pulmonary comorbidities and apply this knowledge in the three steps of patients' management, work-up, diagnosis, and treatment. In this review, we attempt to unravel the pathophysiological mechanisms of this association and also present some evidence for the role of targeted therapy in the treatment of both conditions.
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Affiliation(s)
- Iman Salem
- Department of Dermatology, Case Western Reserve University, Cleveland, USA
| | - Mark Kimak
- Department of Dermatology, Case Western Reserve University, Cleveland, USA
| | - Rosalynn Conic
- Department of Dermatology, Case Western Reserve University, Cleveland, USA
| | - Nicola L. Bragazzi
- Department of Health Sciences (DISSAL), School of Public Health, University of Genoa, Genoa, Italy
| | - Abdulla Watad
- Department of Medicine “B”, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
| | - Mohammad Adawi
- Padeh and Ziv Hospitals, Azrieli Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
| | - Charlie Bridgewood
- Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
| | | | - Pierachille Santus
- Department of Biomedical Sciences L. Sacco, University of Milan, Milan, Italy
- Respiratory Unit, Center for Sleep and Respiratory Disorders, “Luigi Sacco” University Hospital, Milan, Italy
| | - Maurizio Rizzi
- Respiratory Unit, Center for Sleep and Respiratory Disorders, “Luigi Sacco” University Hospital, Milan, Italy
| | - Stephen Petrou
- Emergency Medicine, Good Samaritan Hospital Medical Center, New York, USA
| | - Delia Colombo
- Department of Pharmacology, University of Milan, Milan, Italy
| | - Marco Fiore
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Paolo D. M. Pigatto
- Clinical Dermatology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Giovanni Damiani
- Department of Dermatology, Case Western Reserve University, Cleveland, USA
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Clinical Dermatology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Young Dermatologists Italian Network, Centro Studi GISED, Bergamo, Italy
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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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: 74] [Impact Index Per Article: 14.8] [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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Li B, Ma Z, Xu X, Yin J, Wang X, Ren J, Wang S, Yang J, Ma T, Zhang Q, Yu J, Yan B. Multi-organ involvement of Sweet's syndrome: a case report and literature review. Intern Med 2015; 54:339-43. [PMID: 25748744 DOI: 10.2169/internalmedicine.54.2755] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The hallmark of Sweet's syndrome (SS) is the infiltration of mature neutrophils in the upper dermis. We herein report a case of SS with multi-organ involvement. A 32-year-old man presented with fever, anemia and dyspnea. He was given antibiotics, without any improvements. Later, a number of erythematous lesions appeared, accompanied by deteriorating respiratory and cardiovascular functions. A diagnosis of SS was confirmed on a skin biopsy, and the patient was given corticosteroids, the dose of which was reduced after one month. The organ function subsequently deteriorated, and he ultimately died of multi-organ failure. Early recognition of SS with multi-organ involvement is important in patients with SS.
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Affiliation(s)
- Bo Li
- Department of Respiratory Medicine, Second Clinical Hospital, Jilin University; Department of Occupational Disease Prevention, Jilin Provincial Occupational Disease Prevention and Treatment, China
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