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Shah YR, Tiwari A, Mansour R, Rabinowitz LG. Sweet or Not? Azathioprine-Induced Sweet Syndrome Mimicking Erythema Nodosum in a Patient With Inflammatory Bowel Disease. ACG Case Rep J 2024; 11:e01321. [PMID: 38560019 PMCID: PMC10980489 DOI: 10.14309/crj.0000000000001321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
This case report highlights the clinical challenge and need to distinguish Sweet syndrome and erythema nodosum (EN) in a 50-year-old woman with newly initiated azathioprine for inflammatory bowel disease. While she initially presented with clinical features concerning for drug-induced Sweet syndrome, a subsequent histopathological examination confirmed early-stage EN. Both Sweet syndrome and EN share common triggers and therapeutic responses, but have distinctive clinical characteristics. Subtle histologic differences also exist in lesion distribution and depth of infiltration. This case underscores the need for accurate differentiation in patients with inflammatory bowel disease to initiate appropriate management and avoid potential complications.
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Affiliation(s)
- Yash R. Shah
- Department of Internal Medicine, Wayne State University, Pontiac, MI
- Department of Gastroenterology, Trinity Health Oakland, Pontiac, MI
| | - Angad Tiwari
- Department of Medicine, Maharani Laxmi Bai Medical College, Jhansi, Uttar Pradesh, India
| | - Ramy Mansour
- Department of Gastroenterology, Trinity Health Oakland, Pontiac, MI
| | - Loren G. Rabinowitz
- Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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2
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Commins N, Subhaharan D, Dettrick A, Patrick D. Mercaptopurine-induced Sweet's syndrome. BMJ Case Rep 2024; 17:e259278. [PMID: 38417937 PMCID: PMC10900376 DOI: 10.1136/bcr-2023-259278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Abstract
Sweet's syndrome is an acute febrile neutrophilic dermatosis. Drug-induced Sweet's syndrome typically occurs soon after drug administration, with rapid resolution of symptoms with cessation of the offending agent. We report a man in his early 40s who presented with fever and widespread erythematous rash on a background of recently diagnosed mild stricturing ileal Crohn's disease. He was commenced on 6-mercaptopurine 12 days before presentation. Skin biopsy demonstrated diffuse infiltration of neutrophils in the upper dermis, dermal oedema, eosinophils and fibrin deposition. Symptoms rapidly improved with cessation of 6-mercaptopurine without requiring systemic corticosteroids.
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Affiliation(s)
- Natalie Commins
- Department of Gastroenterology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Deloshaan Subhaharan
- Department of Gastroenterology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Andrew Dettrick
- Department of Pathology, Pathology Queensland, Birtinya, Queensland, Australia
| | - Desmond Patrick
- Department of Gastroenterology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
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Baker O, Chen KS, Kaminska I, Rajagopal V. Sweet syndrome following the ChAdOx1-S vaccine. BMJ Case Rep 2024; 17:e257635. [PMID: 38216167 PMCID: PMC10806861 DOI: 10.1136/bcr-2023-257635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024] Open
Abstract
We report a case of vaccine-induced Sweet syndrome in a female patient in her 50s presenting with fevers and a scattered red patchy rash on the lower limbs. Seven days prior, she had received the first dose of AstraZeneca ChAdOx1-S vaccine. A skin biopsy confirmed Sweet syndrome. She did not respond to high doses of prednisolone and required methotrexate therapy to induce remission. This is one of the first reports of Sweet syndrome caused by the ChAdOx1-S vaccine and provides further evidence for vaccine-induced dermatosis. This case demonstrates that methotrexate can induce remission in cases of Sweet syndrome resistant to corticosteroids. This report also describes an approach to the differential diagnosis of patients presenting with a rash, fever and malaise.
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Affiliation(s)
- Olivia Baker
- General Medicine, West Suffolk Hospitals NHS Trust, Bury Saint Edmunds, Suffolk, UK
| | - Kun Sen Chen
- Dermatology, West Suffolk Hospitals NHS Trust, Bury Saint Edmunds, Suffolk, UK
| | - Iwona Kaminska
- Pathology, West Suffolk Hospitals NHS Trust, Bury Saint Edmunds, Suffolk, UK
| | - Vivek Rajagopal
- General Medicine, West Suffolk Hospitals NHS Trust, Bury Saint Edmunds, Suffolk, UK
- Rheumatology, West Suffolk Hospitals NHS Trust, Bury Saint Edmunds, Suffolk, UK
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4
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Sivanandam LK, Begum B, Martinez EC, Garikipati S, Sanker V, Siddiq A. Azathioprine hypersensitivity: A Sweet-like syndrome. Int J Rheum Dis 2024; 27:e14817. [PMID: 37401805 DOI: 10.1111/1756-185x.14817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 06/14/2023] [Accepted: 06/20/2023] [Indexed: 07/05/2023]
Abstract
INTRODUCTION Azathioprine hypersensitivity can occasionally present as Sweet-like syndrome, a dose-independent side effect characterized by the unanticipated onset of macules, papules, and pustules. CASE PRESENTATION A 35-year-old woman with systemic lupus erythematosus presented with complaints of generalized maculopapular rash, facial swelling, and bilateral lower extremity edema with a duration of 4 days and a 2-day history of constitutional symptoms within 2 weeks of the beginning of azathioprine therapy to treat existing lupus nephritis (class 2/3). DISCUSSION Patients who experience azathioprine hypersensitivity syndrome can present with erythema nodosum, small-vessel vasculitis, acute generalized exanthematous pustulosis, Sweet syndrome, and nonspecific dermatosis. The following signs and symptoms are used as criteria to diagnose drug-induced Sweet syndrome: (a) abrupt onset of painful erythematous plaques, (b) histopathological evidence of dense neutrophilic infiltrate without evidence of leukocytoclastic vasculitis, (c) temperature higher than 39.7°C, (d) temporal relationship between drug ingestion and clinical presentation, and (e) temporal resolution of lesions after drug withdrawal. Our patient met three out of five criteria and was diagnosed with Sweet-like syndrome. CONCLUSION Our case highlights the uncommonly presented azathioprine-induced Sweet-like syndrome that occurs abruptly after the commencement of the offending drug. This diagnosis can be established through basic laboratory workup and skin biopsy findings.
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Affiliation(s)
- Lokesh Koumar Sivanandam
- Sri Lakshmi Narayana Institute of Medical Sciences, Puducherry, India
- Team Erevnites, Trivandrum, India
| | - Benazir Begum
- Team Erevnites, Trivandrum, India
- JIPMER, Puducherry, India
| | - Ernesto Calderon Martinez
- Team Erevnites, Trivandrum, India
- Facultad de Medicina, Univeridad Nacional Autonoma de Mexico, Mexico City, Mexico
| | - Sushmita Garikipati
- Team Erevnites, Trivandrum, India
- Apollo Institute of Medical Sciences and Research, Hyderabad, India
| | - Vivek Sanker
- Team Erevnites, Trivandrum, India
- Noorul Islam Institute of Medical Sciences, Trivandrum, India
| | - Abdelmonem Siddiq
- Team Erevnites, Trivandrum, India
- Faculty of Pharmacy, Mansoura University, Mansoura, Egypt
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Alderazi A, Rezigh AB. An uncommon culprit of neutropenic fever: a case of Sweet syndrome following induction therapy for acute myeloid leukemia. Arch Clin Cases 2023; 10:146-149. [PMID: 38026107 PMCID: PMC10660447 DOI: 10.22551/2023.41.1004.10262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Sweet syndrome (SS) is a rare inflammatory disorder characterized by the rapid onset of a characteristically tender rash, fever, and other systemic symptoms. These manifestations are often mistaken for an infection that is not responding to antimicrobials, especially in immunocompromised hosts. We present the case of a 44-year-old woman who developed SS following induction chemotherapy for newly diagnosed acute myeloid leukemia (AML). She exhibited a painful rash on the anterior chest, which spread centrifugally, along with neutropenic fever unresponsive to broad-spectrum antimicrobials. Biopsy of the rash revealed a dense neutrophilic infiltrate within the dermis, confirming the diagnosis of SS. The patient was subsequently treated with systemic steroids with prompt resolution of fevers and improvement of her rash. This case highlights that SS can manifest with a robust neutrophilic infiltrate, even in the context of neutropenia stemming from chemotherapy. SS serves as a crucial consideration in hematologic malignancies, particularly AML, when patients present with fever and cutaneous eruptions. Prompt recognition followed by systemic steroid therapy often leads to symptom resolution.
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Affiliation(s)
- Ahmed Alderazi
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Alec B. Rezigh
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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Calabrese L, Ney F, Aoki R, Moltrasio C, Marzano AV, Kerl K, Stadler PC, Satoh TK, French LE. Characterisation of IL-1 family members in Sweet syndrome highlights the overexpression of IL-1β and IL-1R3 as possible therapeutic targets. Exp Dermatol 2023; 32:1915-1923. [PMID: 37724787 DOI: 10.1111/exd.14916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 08/04/2023] [Accepted: 08/18/2023] [Indexed: 09/21/2023]
Abstract
Sweet syndrome (SS) as a prototypic neutrophilic dermatosis (NDs) shares certain clinical and histologic features with monogenic auto-inflammatory disorders in which interleukin (IL)-1 cytokine family members play an important role. This has led to the proposal that NDs are polygenic auto-inflammatory diseases and has fuelled research to further understand the role of IL-1 family members in the pathogenesis of NDs. The aim of this study was to characterise the expression of the IL-1 family members IL-1β, IL-36γ, IL-33 and IL-1R3 (IL-1RaP) in SS. The expression profile of IL-1β, IL-33, IL-36γ and their common co-receptor IL-1R3 was analysed by immunohistochemistry, in situ hybridisation and double immunofluorescence (IF) in healthy control skin (HC) and lesional skin samples of SS. Marked overexpression of IL-1β in the dermis of SS (p < 0.001), and a non-significant increase in dermal (p = 0.087) and epidermal (p = 0.345) IL-36γ expression compared to HC was observed. Significantly increased IL-1R3 expression within the dermal infiltrate of SS skin samples (p = 0.02) was also observed, whereas no difference in IL-33 expression was found between SS and HC (p = 0.7139). In situ hybridisation revealed a good correlation between gene expression levels and the above protein expression levels. Double IF identifies neutrophils and macrophages as the predominant sources of IL-1β. This study shows that IL-1β produced by macrophages and neutrophils and IL-1R3 are significantly overexpressed in SS, thereby indicating a potential pathogenic role for this cytokine and receptor in SS.
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Affiliation(s)
- Laura Calabrese
- Department of Dermatology and Allergy, University Hospital LMU, Munich, Germany
- Institute of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Francesca Ney
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rui Aoki
- Department of Dermatology and Allergy, University Hospital LMU, Munich, Germany
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Katrin Kerl
- Department of Dermatology and Allergy, University Hospital LMU, Munich, Germany
| | | | - Takashi K Satoh
- Department of Dermatology and Allergy, University Hospital LMU, Munich, Germany
| | - Lars E French
- Department of Dermatology and Allergy, University Hospital LMU, Munich, Germany
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
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Zhu H, Ren V. Warm, Erythematous, Edematous Plaques With Overlying Vesicles on the Thigh: Answer. Am J Dermatopathol 2023; 45:773. [PMID: 37856741 DOI: 10.1097/dad.0000000000002552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Affiliation(s)
- Harrison Zhu
- School of Medicine, Baylor College of Medicine, Houston, TX; and
| | - Vicky Ren
- Department of Dermatology, Baylor College of Medicine, Houston, TX
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8
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Walker BA, Stull LB, Hines JP. A Sweet Voice: Acute Febrile Neutrophilic Dermatosis of the Larynx. EAR, NOSE & THROAT JOURNAL 2023; 102:629-631. [PMID: 34121481 DOI: 10.1177/01455613211022098] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
SIGNIFICANCE STATEMENT Acute febrile neutrophilic dermatosis (Sweet syndrome) is a rare idiopathic condition characterized by fever and whole-body rash of tender erythematous plaques of unknown etiology. Otorhinolaryngologic manifestations of the disease can be severe, yet they are sparsely reported in the literature. We present the first documented case of laryngeal involvement of Sweet syndrome.
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Affiliation(s)
- Brian A Walker
- Department of Otorhinolaryngology, The Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Lindsey B Stull
- Department of Otorhinolaryngology, The Mayo Clinic Arizona, Phoenix, AZ, USA
| | - J Peyton Hines
- Department of Otorhinolaryngology, The Mayo Clinic Arizona, Phoenix, AZ, USA
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Nazaretyan S, Ali A, Yaghmour G, Tong A, Castillo V, Rodrigues S, Ladha A, Woan K, Tam E, Shi SY, Bateshansky D, Chaudhary PM. Unique challenges to diagnosing sweet syndrome following induction chemotherapy for relapsed Acute Myeloid Leukemia (AML): A case and brief-review. Respir Med Case Rep 2023; 46:101922. [PMID: 37841284 PMCID: PMC10570145 DOI: 10.1016/j.rmcr.2023.101922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/04/2023] [Accepted: 09/29/2023] [Indexed: 10/17/2023] Open
Abstract
Background Sweet Syndrome (SS) is a rare inflammatory skin condition characterized by the sudden appearance of tender, erythematous or violaceous papules, plaques, and nodules typically found on the face, neck, shoulder, upper extremities, and trunk. Often, SS is difficult to diagnose because of its various non-specific manifestations, including fever, arthralgia, myalgia and ocular involvement. In most cases described in literature, cutaneous and pulmonary symptoms of SS present in a concomitant manner. Several reported cases of pulmonary SS have shown that if left untreated, acute respiratory distress syndrome can ensue and progress to fatal respiratory failure. Case report A 58-year-old female with acute myeloid leukemia (AML) secondary to chronic lymphocytic leukemia (CLL) presented with new nodular lesions, dyspnea, and fevers. Chest X-ray revealed pulmonary infiltrates. The patient developed new facial lesions and worsening hypoxic respiratory failure. Further infectious workup was negative. She was found to have SS with pulmonary involvement and initiated on high-dose intravenous (IV) steroids with marked clinical improvement. Conclusions Major and minor criteria for the diagnosis of lung-associated SS should be carefully evaluated, especially when a biopsy is unavailable. The following case report describes the clinical course and outcomes from treatment for this patient.
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Affiliation(s)
- Samvel Nazaretyan
- University of Southern California, Keck School of Medicine, LA, USA
- Nohl Division of Hematology and Center for the Study of Blood Diseases, Department of Medicine, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Amir Ali
- University of Southern California, Keck School of Medicine, LA, USA
- Nohl Division of Hematology and Center for the Study of Blood Diseases, Department of Medicine, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - George Yaghmour
- University of Southern California, Keck School of Medicine, LA, USA
- Nohl Division of Hematology and Center for the Study of Blood Diseases, Department of Medicine, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Anhthy Tong
- University of Southern California, Keck School of Medicine, LA, USA
- Nohl Division of Hematology and Center for the Study of Blood Diseases, Department of Medicine, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Vanessa Castillo
- University of Southern California, Keck School of Medicine, LA, USA
- Nohl Division of Hematology and Center for the Study of Blood Diseases, Department of Medicine, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Sonia Rodrigues
- University of Southern California, Keck School of Medicine, LA, USA
- Nohl Division of Hematology and Center for the Study of Blood Diseases, Department of Medicine, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Abdullah Ladha
- University of Southern California, Keck School of Medicine, LA, USA
- Nohl Division of Hematology and Center for the Study of Blood Diseases, Department of Medicine, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Karrune Woan
- University of Southern California, Keck School of Medicine, LA, USA
- Nohl Division of Hematology and Center for the Study of Blood Diseases, Department of Medicine, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Eric Tam
- University of Southern California, Keck School of Medicine, LA, USA
- Nohl Division of Hematology and Center for the Study of Blood Diseases, Department of Medicine, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Samantha Y. Shi
- University of Southern California, Keck School of Medicine, LA, USA
- Nohl Division of Hematology and Center for the Study of Blood Diseases, Department of Medicine, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - David Bateshansky
- University of Southern California, Keck School of Medicine, LA, USA
- Nohl Division of Hematology and Center for the Study of Blood Diseases, Department of Medicine, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Preet M. Chaudhary
- University of Southern California, Keck School of Medicine, LA, USA
- Nohl Division of Hematology and Center for the Study of Blood Diseases, Department of Medicine, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
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10
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Martin S, Trenque T, Herlem E, Boulay C, Pizzoglio V, Azzouz B. Drug-induced Sweet's syndrome: A case/non-case study in the French pharmacovigilance database. Br J Clin Pharmacol 2023. [PMID: 37555568 DOI: 10.1111/bcp.15873] [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: 01/20/2023] [Revised: 07/10/2023] [Accepted: 07/26/2023] [Indexed: 08/10/2023] Open
Abstract
AIMS Sweet's syndrome is an acute febrile neutrophilic dermatosis first described in 1964 by Robert Douglas Sweet. The pathophysiological mechanism is not fully established; however, several cases of Sweet's syndrome have been reported following drug administration. METHODS To investigate the existence of pharmacovigilance signals between drugs and the occurrence of Sweet's syndrome, we performed a case/non-case study on reports of 'acute febrile neutrophilic dermatosis' registered in the French pharmacovigilance database. Reporting odds ratio (ROR) with its 95% confidence interval were calculated. RESULTS Amongthe 994 789 reports recorded in the database, 136 were Sweet's syndrome, of which 50.7% were men and the median age was 59 years (range 15-91). A total of 224 drugs were mentioned as suspects: 21.0% were antibacterials, 19.2% were antineoplastics and 12.1% were immunosuppressants. Median time to onset from drug initiation to the development of Sweet's syndrome was 15 days (range 1-1095). The highest RORs were observed with bortezomib (74.04 [40.8-134.2]), azacitidine (72.14 [29.4-176.9]), perfilgrastim (67.05 [21.2-211.6]), azathioprine (55.46 [34.8-88.4]) and bendamustine (35.84 [11.4-112.8]). CONCLUSIONS Pharmacovigilance signals have been observed between the occurrence of Sweet's syndrome and colony-stimulating factors, immunosuppressants, antineoplastics and antibiotics. Clinicians should be aware of the potential associations with these drugs and should be encouraged to report any case of drug-induced Sweet's syndrome.
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Affiliation(s)
- Salomé Martin
- Regional Centre of Pharmacovigilance and Pharmacoepidemiology, Reims University Hospital, 51100, Reims, France
| | - Thierry Trenque
- Regional Centre of Pharmacovigilance and Pharmacoepidemiology, Reims University Hospital, 51100, Reims, France
| | - Emmanuelle Herlem
- Regional Centre of Pharmacovigilance and Pharmacoepidemiology, Reims University Hospital, 51100, Reims, France
| | - Charlène Boulay
- Regional Centre of Pharmacovigilance and Pharmacoepidemiology, Rouen University Hospital, 76000, Rouen, France
| | - Véronique Pizzoglio
- Regional Centre of Pharmacovigilance and Pharmacoepidemiology, Lyon University Hospital, 69495, Lyon, France
| | - Brahim Azzouz
- Regional Centre of Pharmacovigilance and Pharmacoepidemiology, Reims University Hospital, 51100, Reims, France
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Keen JA, Fisher MD, Yu CY, Swick BL, Shriver EM. Elevated Intraocular Pressure in Periorbital Sweet's Syndrome. Ophthalmic Plast Reconstr Surg 2023; 39:e115-e117. [PMID: 36893059 DOI: 10.1097/iop.0000000000002373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
A 66-year-old immunocompromised man presented with cellulitis around the left eye that was initially concerning for necrotizing fasciitis. Exam findings were remarkable for exquisite periocular tenderness with rigid, immobile eyelids resulting from severe erythema, edema, and induration. Given the concern for orbital compartment syndrome and a necrotizing infection, the patient was taken urgently to the operating room for debridement of the eyelid skin as well as an urgent lateral canthotomy and cantholysis. His eye exam revealed 360° of hemorrhagic chemosis, no relative afferent pupillary defect, and an ipsilateral elevated intraocular pressure of 35 mm Hg. No visual acuity measurement could be obtained secondary to the patient's altered mental status. His intraocular pressure normalized after treatment with antihypertensive drops and further extension of the canthotomy. Histopathological analysis showed extensive neutrophilic infiltrate of the dermis which was compatible with a diagnosis of Sweet's syndrome.
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Affiliation(s)
- Jamie A Keen
- University of Iowa Department of Ophthalmology and Visual Sciences, University of Iowa
| | - Mark D Fisher
- University of Iowa Department of Plastic Surgery, University of Iowa
| | - Caroline Y Yu
- University of Iowa Department of Ophthalmology and Visual Sciences, University of Iowa
| | - Brian L Swick
- University of Iowa Department of Dermatology, University of Iowa
- University of Iowa Department of Pathology, University of Iowa, Iowa City, Iowa, U.S.A
| | - Erin M Shriver
- University of Iowa Department of Ophthalmology and Visual Sciences, University of Iowa
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12
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Hung YT, Huang YL, Wu J. Drug-Induced Subcutaneous Sweet Syndrome. Mayo Clin Proc 2023; 98:631-632. [PMID: 37019517 DOI: 10.1016/j.mayocp.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/24/2022] [Accepted: 12/08/2022] [Indexed: 04/07/2023]
Affiliation(s)
- Yi-Teng Hung
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Yau-Li Huang
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Cosmetic Science, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Jennifer Wu
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Cosmetic Science, Chang Gung University of Science and Technology, Taoyuan, Taiwan.
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13
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Al Bshabshe A, Mousa WF, Nor El-Dein N. An Overview of Clinical Manifestations of Dermatological Disorders in Intensive Care Units: What Should Intensivists Be Aware of? Diagnostics (Basel) 2023; 13:diagnostics13071290. [PMID: 37046508 PMCID: PMC10093365 DOI: 10.3390/diagnostics13071290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/01/2023] [Accepted: 03/07/2023] [Indexed: 03/31/2023] Open
Abstract
Acute skin failure is rarely the primary diagnosis that necessitates admission to an intensive care unit. Dermatological manifestations in critically ill patients, on the other hand, are relatively common and can be used to make a key diagnosis of an adverse drug reaction or an underlying systemic illness, or they may be caused by factors related to a prolonged stay or invasive procedures. In intensive care units, their classification is based on the aetiopathogenesis of the cutaneous lesion and, in the meantime, distinguishes critical patients. When evaluating dermatological manifestations, several factors must be considered: onset, morphology, distribution, and associated symptoms and signs. This review depicts dermatological signs in critical patients in order to lay out better recognition.
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Histiocytoid Sweet Syndrome Presenting in Two Sisters With Deficiency of Deaminase Type 2. Am J Dermatopathol 2023; 45:47-50. [PMID: 36484606 DOI: 10.1097/dad.0000000000002286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
ABSTRACT Deficiency of adenosine deaminase type 2 (DADA2) is an autosomal recessive monogenic autoinflammatory syndrome that is classically characterised by polyarteritis nodosa, systemic vasculitis and stroke. The spectrum of disease manifestations has broadened to encompass a range of cutaneous, vascular and haematological manifestations. We report a novel association in two sisters with heterozygous p.R169G/p.M309l mutations in ADA2 with low serum ADA2 activity who both presented similarly with clinical and histological features consistent with histiocytoid Sweet syndrome.
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15
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Oganesyan A, Gregory A, Malard F, Ghahramanyan N, Mohty M, Kazandjian D, Mekinian A, Hakobyan Y. Monoclonal gammopathies of clinical significance (MGCS): In pursuit of optimal treatment. Front Immunol 2022; 13:1045002. [PMID: 36505449 PMCID: PMC9728929 DOI: 10.3389/fimmu.2022.1045002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/07/2022] [Indexed: 11/24/2022] Open
Abstract
Monoclonal gammopathy of clinical significance (MGCS) represents a new clinical entity referring to a myriad of pathological conditions associated with the monoclonal gammopathy of undetermined significance (MGUS). The establishment of MGCS expands our current understanding of the pathophysiology of a range of diseases, in which the M protein is often found. Aside from the kidney, the three main organ systems most affected by monoclonal gammopathy include the peripheral nervous system, skin, and eye. The optimal management of these MGUS-related conditions is not known yet due to the paucity of clinical data, the rarity of some syndromes, and limited awareness among healthcare professionals. Currently, two main treatment approaches exist. The first one resembles the now-established therapeutic strategy for monoclonal gammopathy of renal significance (MGRS), in which chemotherapy with anti-myeloma agents is used to target clonal lesion that is thought to be the culprit of the complex clinical presentation. The second approach includes various systemic immunomodulatory or immunosuppressive options, including intravenous immunoglobulins, corticosteroids, or biological agents. Although some conditions of the MGCS spectrum can be effectively managed with therapies aiming at the etiology or pathogenesis of the disease, evidence regarding other pathologies is severely limited to individual patient data from case reports or series. Future research should pursue filling the gap in knowledge and finding the optimal treatment for this novel clinical category.
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Affiliation(s)
- Artem Oganesyan
- Department of Hematology and Transfusion Medicine, National Institute of Health, Yerevan, Armenia,Department Of Adult Hematology, Hematology Center after Prof. R. Yeolyan, Yerevan, Armenia,*Correspondence: Artem Oganesyan,
| | - Andrew Gregory
- Wayne State University School of Medicine, Detroit, MI, United States
| | - Florent Malard
- Department of Clinical Hematology and Cellular Therapy, INSERM, Saint-Antoine Research Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Saint Antoine, Paris, France
| | - Nerses Ghahramanyan
- Department Of Adult Hematology, Hematology Center after Prof. R. Yeolyan, Yerevan, Armenia
| | - Mohamad Mohty
- Department of Clinical Hematology and Cellular Therapy, INSERM, Saint-Antoine Research Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Saint Antoine, Paris, France
| | - Dickran Kazandjian
- Myeloma Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States
| | - Arsène Mekinian
- Department of Internal Medicine (DMU i3), Sorbonne University, Assistance Publique-Hôpitaux de Paris, Hôpital Saint Antoine, Paris, France,French-Armenian Clinical Research Center, National Institute of Health, Yerevan, Armenia
| | - Yervand Hakobyan
- Department of Hematology and Transfusion Medicine, National Institute of Health, Yerevan, Armenia,Department Of Adult Hematology, Hematology Center after Prof. R. Yeolyan, Yerevan, Armenia
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16
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Ambur AB, Nyckowski TA. Subcutaneous Sweet's syndrome: a rare subtype of acute febrile neutrophilic dermatosis. J Osteopath Med 2022; 122:645-647. [PMID: 36018714 DOI: 10.1515/jom-2022-0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 07/01/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Austin B Ambur
- Kansas City University at Advanced Dermatology and Cosmetic Surgery, Orlando, FL, USA
| | - Timothy A Nyckowski
- Kansas City University at Advanced Dermatology and Cosmetic Surgery, Orlando, FL, USA
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17
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Consalvo KM, Kirolos SA, Sestak CE, Gomer RH. Sex-Based Differences in Human Neutrophil Chemorepulsion. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2022; 209:354-367. [PMID: 35793910 PMCID: PMC9283293 DOI: 10.4049/jimmunol.2101103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/02/2022] [Indexed: 05/25/2023]
Abstract
A considerable amount is known about how eukaryotic cells move toward an attractant, and the mechanisms are conserved from Dictyostelium discoideum to human neutrophils. Relatively little is known about chemorepulsion, where cells move away from a repellent signal. We previously identified pathways mediating chemorepulsion in Dictyostelium, and here we show that these pathways, including Ras, Rac, protein kinase C, PTEN, and ERK1 and 2, are required for human neutrophil chemorepulsion, and, as with Dictyostelium chemorepulsion, PI3K and phospholipase C are not necessary, suggesting that eukaryotic chemorepulsion mechanisms are conserved. Surprisingly, there were differences between male and female neutrophils. Inhibition of Rho-associated kinases or Cdc42 caused male neutrophils to be more repelled by a chemorepellent and female neutrophils to be attracted to the chemorepellent. In the presence of a chemorepellent, compared with male neutrophils, female neutrophils showed a reduced percentage of repelled neutrophils, greater persistence of movement, more adhesion, less accumulation of PI(3,4,5)P3, and less polymerization of actin. Five proteins associated with chemorepulsion pathways are differentially abundant, with three of the five showing sex dimorphism in protein localization in unstimulated male and female neutrophils. Together, this indicates a fundamental difference in a motility mechanism in the innate immune system in men and women.
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Affiliation(s)
| | - Sara A Kirolos
- Department of Biology, Texas A&M University, College Station, TX
| | - Chelsea E Sestak
- Department of Biology, Texas A&M University, College Station, TX
| | - Richard H Gomer
- Department of Biology, Texas A&M University, College Station, TX
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18
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Gnesotto L, Mioso G, Alaibac M. Use of granulocyte and monocyte adsorption apheresis in dermatology (Review). Exp Ther Med 2022; 24:536. [PMID: 35837066 PMCID: PMC9257973 DOI: 10.3892/etm.2022.11463] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/24/2022] [Indexed: 12/04/2022] Open
Abstract
Adsorptive granulocyte and monocyte apheresis (GMA) is an extracorporeal treatment that selectively removes activated myeloid lineage leukocytes from peripheral blood. This technique consists of a column with cellulose acetate beads as absorptive leukocytapheresis carriers, and was initially used to treat ulcerative colitis. A literature search was conducted to extract recently published studies about the clinical efficacy of GMA in patients with different skin disorders, reporting information on demographics, clinical symptoms, treatment and clinical course. Dermatological diseases, in which GMA has been performed, include generalized pustular psoriasis, pyoderma gangrenosum, palmoplantar pustular psoriasis, Behcet's disease, Sweet's syndrome, adult-onset Still's disease, impetigo herpetiformis, reactive arthritis, acne and hidradenitis suppurativa syndrome, cutaneous allergic vasculitis and systemic lupus erythematosus. In most patients, GMA was started after the failure of conventional therapeutic options and it was helpful in the majority of cases. Based on the information summarized, GMA could be considered a valid non-pharmacological treatment option for patients with several dermatological conditions, which are difficult to treat with other pharmacological preparations.
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Affiliation(s)
- Laura Gnesotto
- Dermatology Unit, Department of Medicine, University of Padova, I‑35128 Padova, Italy
| | - Guido Mioso
- Dermatology Unit, Department of Medicine, University of Padova, I‑35128 Padova, Italy
| | - Mauro Alaibac
- Dermatology Unit, Department of Medicine, University of Padova, I‑35128 Padova, Italy
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19
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Tognetti L, Cinotti E, Falcinelli F, Miracco C, Suppa M, Perrot JL, Rubegni P. Line-field confocal optical coherence tomography: a new tool for non-invasive differential diagnosis of pustular skin disorders. J Eur Acad Dermatol Venereol 2022; 36:1873-1883. [PMID: 35694879 PMCID: PMC9544527 DOI: 10.1111/jdv.18324] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/29/2022] [Indexed: 12/24/2022]
Abstract
Background The spectrum of pustular skin disorders (PSD) is large and particularly challenging, including inflammatory, infectious and amicrobial diseases. Moreover, although pustules represent the unifying clinical feature, they can be absent or not fully developed in the early stage of the disease. The line‐field confocal optical coherence tomography (LC‐OCT) is a recently developed imaging technique able to perform a non‐invasive, in vivo, examination of the epidermis and upper dermis, reaching very high image resolution and virtual histology. Objectives We aimed to investigate the potentialities of LC‐OCT in the non‐invasive differential diagnosis of a series of 11 PSD with different aetiology, microscopic features, body location and incidence rates. Materials and Methods Complete LC‐OCT imaging (i.e. 2D/3D frames, videos) was performed on a total of 19 patients (10 females and 9 males) aged between 35 and 79 years. Images were blindly evaluated and compared with corresponding histopathologic findings. Results The LC‐OCT imaging was able to detect with high accuracy the pustule structure including shape, margins, morphology and cellular content, along with peculiar epidermal and adnexal alterations in each condition, including: Acute Generalized Exanthematous Pustulosis, Generalized pustular psoriasis, Generalized pustular figurate erythema, Subcorneal Pustular Dermatosis, Intraepidermal IgA pustulosis, Palmoplantar pustulosis, Palmoplantar pustular psoriasis. Herpetic whitlow, Acrodermatitis continua of Hallopeau, Vesicopustular Sweet syndrome and Vesicopustular Eosinophilic cellulitis, with pustular appearance, were also compared. Conclusions The new LC‐OCT can represent a rapid, non‐invasive and painless tool which can help differentiating among PSD of different aetiology and microscopic morphology in clinical mimickers in daily practice.
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Affiliation(s)
- L Tognetti
- Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neurosciences, Siena University Hospital, Siena, Italy
| | - E Cinotti
- Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neurosciences, Siena University Hospital, Siena, Italy.,Groupe d'Imagerie Cutanée Non-Invasive (GICNI) of the Société Française de Dermatologie (SFD), Paris, France
| | - F Falcinelli
- Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neurosciences, Siena University Hospital, Siena, Italy
| | - C Miracco
- Department of Medicine, Surgery and Neurosciences Pathological Anatomy Section, University of Siena, Siena, Italy
| | - M Suppa
- Groupe d'Imagerie Cutanée Non-Invasive (GICNI) of the Société Française de Dermatologie (SFD), Paris, France.,Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.,Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - J-L Perrot
- Groupe d'Imagerie Cutanée Non-Invasive (GICNI) of the Société Française de Dermatologie (SFD), Paris, France.,Dermatology Unit, University Hospital of St-Etienne, Saint Etienne, France
| | - P Rubegni
- Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neurosciences, Siena University Hospital, Siena, Italy
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20
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Jung EH, Park JH, Hwan Kim K, Kim JS, Sil Choi I, Byun JM, Koh Y, Shin DY, Hong J, Yoon SS, Park H, Kim I. Characteristics of Sweet syndrome in patients with or without malignancy. Ann Hematol 2022; 101:1499-1508. [PMID: 35482090 DOI: 10.1007/s00277-022-04850-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/19/2022] [Indexed: 11/30/2022]
Abstract
Sweet syndrome is a neutrophilic dermatosis occasionally associated with malignancies. Due to its rarity, the clinical features of Sweet syndrome are still unclear. Thus, we aimed to analyze clinical features, treatment, and outcomes of these patients according to associated disease. We conducted a retrospective, longitudinal cohort study from January 2000 to August 2020. We reviewed the medical records of 52 patients with Sweet syndrome. The median age of patients was 57.5 years old (range, 17-84), and 48.1% were female. Of the 52 patients analyzed, 27 patients (51.9%) had malignancy-associated Sweet syndrome. Sweet syndrome was diagnosed concurrently with (N = 8), before (N = 5), and after (N = 14) the diagnosis of malignancy. The idiopathic Sweet syndrome was most common in the non-malignancy group (56.0%). Myelodysplastic syndrome was the most common malignancy associated with Sweet syndrome (47.6%). Leukopenia (p = 0.005), anemia (p < 0.001), and thrombocytopenia (p = 0.008) were significantly associated with malignancy. The majority of patients showed rapid improvement of symptoms after steroid administration. The symptoms of some patients with malignancy did not improve with steroid alone; however, their symptoms often improved when steroids were combined with a treatment for the associated malignancy. Relapse and aggravation of Sweet syndrome were common in the malignancy group. Sweet syndrome showed a broad spectrum of clinical features related to various diseases. Sweet syndrome often occurred as a paraneoplastic feature. Therefore, active systemic evaluation is needed in the first diagnosis of Sweet syndrome without clear etiology.
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Affiliation(s)
- Eun Hee Jung
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Jin Hyun Park
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Ki Hwan Kim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Jin-Soo Kim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - In Sil Choi
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Ja Min Byun
- Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul, 03080, South Korea
| | - Youngil Koh
- Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul, 03080, South Korea
| | - Dong-Yeop Shin
- Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul, 03080, South Korea
| | - Junshik Hong
- Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul, 03080, South Korea
| | - Sung-Soo Yoon
- Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul, 03080, South Korea
| | - Hyunkyung Park
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea.
- Department of Hematology and Oncology, Seoul National University, Boramae Medical Center 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, South Korea.
| | - Inho Kim
- Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul, 03080, South Korea.
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21
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A Rare Case of Midostaurin-Associated Sweet’s Syndrome. Case Rep Hematol 2022; 2022:1099005. [PMID: 35495179 PMCID: PMC9054466 DOI: 10.1155/2022/1099005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 01/06/2023] Open
Abstract
Acute febrile neutrophilic dermatosis which is referred as Sweet's syndrome (SS) is a dermatological condition characterized by fever, erythematous rash, and leukocytosis. SS can be idiopathic or associated with malignancies or medications. We present a rare case of SS which developed shortly after starting midostaurin in a patient with acute myelogenous leukemia (AML).
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22
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Kaushik A, Kumaran MS, Bishnoi A, Chatterjee D. Photosensitive Sweet syndrome: An uncommon entity. Indian J Dermatol Venereol Leprol 2022; 88:581. [PMID: 35593291 DOI: 10.25259/ijdvl_201_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 10/01/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Akanksha Kaushik
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Muthu Sendhil Kumaran
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anuradha Bishnoi
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Debajyoti Chatterjee
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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23
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Santos MI, Mestre A, Teixeira N, Correia C, Brochado M. Sweet's Syndrome: A Case Report of a Rare Extraintestinal Manifestation of Ulcerative Colitis. Cureus 2022; 14:e22980. [PMID: 35281580 PMCID: PMC8905119 DOI: 10.7759/cureus.22980] [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] [Accepted: 03/08/2022] [Indexed: 11/29/2022] Open
Abstract
Sweet’s syndrome is a neutrophilic dermatosis of unknown etiology and a rare extraintestinal manifestation of ulcerative colitis. Classically, it is more common in women with active inflammatory bowel disease (IBD). This syndrome typically presents in patients with acute-onset painful tender erythematous skin lesions and is usually accompanied by fever, arthralgia, and elevated inflammatory markers. Histological examination is characterized by diffuse dense dermal neutrophilic infiltrate with leukocytoclasia, without vasculitis. The treatment goals are to reduce morbidity and complications, and the most effective therapy is systemic corticosteroids. Early recognition of this syndrome is essential to improve our diagnostic and therapeutic abilities. We report a case of a 59-year-old female with ulcerative colitis, which presented with manifestations of Sweet’s syndrome.
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24
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Dastoli S, Nisticò SP, Morrone P, Patruno C, Leo A, Citraro R, Gallelli L, Russo E, De Sarro G, Bennardo L. Colchicine in Managing Skin Conditions: A Systematic Review. Pharmaceutics 2022; 14:pharmaceutics14020294. [PMID: 35214027 PMCID: PMC8878049 DOI: 10.3390/pharmaceutics14020294] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 12/13/2022] Open
Abstract
(1) Background: Colchicine is a natural alkaloid with anti-inflammatory properties used to treat various disorders, including some skin diseases. This paper aims to incorporate all the available studies proposing colchicine as a treatment alternative in the management of cutaneous conditions. (2) Methods: In this systematic review, the available articles present in various databases (PubMed, Scopus-Embase, and Web of Science), proposing colchicine as a treatment for cutaneous pathological conditions, have been selected. Exclusion criteria included a non-English language and non-human studies. (3) Results: Ninety-six studies were included. Most of them were case reports and case series studies describing colchicine as single therapy, or in combination with other drugs. Hidradenitis suppurativa, pyoderma gangrenosum, erythema nodosum, erythema induratum, storage diseases, perforating dermatosis, bullous diseases, psoriasis, vasculitis, acne, urticaria, stomatitis, actinic keratosis, and pustular dermatosis were the main diseases discussed in literature. Although the therapeutic outcomes were variable, most of the studies reported, on average, good clinical results (4) Conclusions: Colchicine could be, as a single therapy or in combination with other drugs, a possible treatment to manage several skin diseases.
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Affiliation(s)
- Stefano Dastoli
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (S.D.); (S.P.N.); (C.P.); (A.L.); (R.C.); (L.G.); (E.R.); (G.D.S.)
| | - Steven Paul Nisticò
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (S.D.); (S.P.N.); (C.P.); (A.L.); (R.C.); (L.G.); (E.R.); (G.D.S.)
| | | | - Cataldo Patruno
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (S.D.); (S.P.N.); (C.P.); (A.L.); (R.C.); (L.G.); (E.R.); (G.D.S.)
| | - Antonio Leo
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (S.D.); (S.P.N.); (C.P.); (A.L.); (R.C.); (L.G.); (E.R.); (G.D.S.)
| | - Rita Citraro
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (S.D.); (S.P.N.); (C.P.); (A.L.); (R.C.); (L.G.); (E.R.); (G.D.S.)
| | - Luca Gallelli
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (S.D.); (S.P.N.); (C.P.); (A.L.); (R.C.); (L.G.); (E.R.); (G.D.S.)
| | - Emilio Russo
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (S.D.); (S.P.N.); (C.P.); (A.L.); (R.C.); (L.G.); (E.R.); (G.D.S.)
| | - Giovambattista De Sarro
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (S.D.); (S.P.N.); (C.P.); (A.L.); (R.C.); (L.G.); (E.R.); (G.D.S.)
| | - Luigi Bennardo
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (S.D.); (S.P.N.); (C.P.); (A.L.); (R.C.); (L.G.); (E.R.); (G.D.S.)
- Azienda Ospedaliera di Cosenza, 87100 Cosenza, Italy;
- Correspondence: ; Tel.: +39-09-613627195
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25
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Cordts I, Hecker JS, Gauck D, Park J, Härtl J, Günthner R, Hammitzsch A, Schoser B, Abeck D, Götze KS, Haack TB, Deschauer M, Moog P, Hemmer B. Successful treatment with azacitidine in VEXAS syndrome with prominent myofasciitis. Rheumatology (Oxford) 2021; 61:e117-e119. [PMID: 34894213 DOI: 10.1093/rheumatology/keab866] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/11/2021] [Accepted: 11/13/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Isabell Cordts
- Department of Neurology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Judith S Hecker
- Department of Medicine III, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Darja Gauck
- Institute of Medical Genetics and Applied Genomics,University of Tübingen, Tübingen, Germany
| | - Joohyun Park
- Institute of Medical Genetics and Applied Genomics,University of Tübingen, Tübingen, Germany
| | - Johanna Härtl
- Department of Neurology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Roman Günthner
- Department of Nephrology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Ariane Hammitzsch
- Department of Nephrology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Benedikt Schoser
- Department of Neurology, Friedrich-Baur-Institute, Ludwig-Maximilians University, Munich, Germany
| | | | - Katharina S Götze
- Department of Medicine III, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Tobias B Haack
- Institute of Medical Genetics and Applied Genomics,University of Tübingen, Tübingen, Germany.,Centre for Rare Diseases, University of Tübingen, Tübingen, Germany
| | - Marcus Deschauer
- Department of Neurology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Philipp Moog
- Department of Nephrology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany.,MVZ für Rheumatologie Dr. Martin Welcker, Planegg, Germany
| | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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26
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Al-Hayani AWM, Alemany IM, Santonja C, Úbeda AC, Pérez LP, Ceballos-Rodríguez MC, Acosta IC, Hernández-Mora MDG, Álvarez BÁ. Histiocytoid Sweet Syndrome associated with anorectal lymphogranuloma venereum in a patient with HIV infection. Int J Infect Dis 2021; 115:106-108. [PMID: 34838958 DOI: 10.1016/j.ijid.2021.11.030] [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: 11/10/2021] [Revised: 11/15/2021] [Accepted: 11/20/2021] [Indexed: 10/19/2022] Open
Abstract
Sweet Syndrome belongs to a group of diseases known as neutrophilic dermatoses. An uncommon variant named Histiocytoid Sweet Syndrome (HSS) can be associated with a variety of conditions, including cancer, infections, drug toxicity and others. Here we present an instance of HSS in an HIV-positive patient in an infectious disease setting.
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Affiliation(s)
- Aws Waleed M Al-Hayani
- Division of Infectious Diseases. Fundación Jiménez Díaz University Hospital. Universidad Autónoma de Madrid (IIS-FJD, UAM). Madrid, Spain.
| | - Iris Martínez Alemany
- Division of Infectious Diseases. Fundación Jiménez Díaz University Hospital. Universidad Autónoma de Madrid (IIS-FJD, UAM). Madrid, Spain
| | - Carlos Santonja
- Department of Pathology, Fundación Jiménez Díaz University Hospital. Universidad Autónoma de Madrid (IIS-FJD, UAM). Madrid, Spain
| | - Alfonso Cabello Úbeda
- Division of Infectious Diseases. Fundación Jiménez Díaz University Hospital. Universidad Autónoma de Madrid (IIS-FJD, UAM). Madrid, Spain
| | - Laura Prieto Pérez
- Division of Infectious Diseases. Fundación Jiménez Díaz University Hospital. Universidad Autónoma de Madrid (IIS-FJD, UAM). Madrid, Spain
| | - María Carmen Ceballos-Rodríguez
- Department of Dermatology, Fundación Jiménez Díaz University Hospital. Universidad Autónoma de Madrid (IIS-FJD, UAM). Madrid, Spain
| | - Irene Carrillo Acosta
- Division of Infectious Diseases. Fundación Jiménez Díaz University Hospital. Universidad Autónoma de Madrid (IIS-FJD, UAM). Madrid, Spain
| | - Miguel de Górgolas Hernández-Mora
- Division of Infectious Diseases. Fundación Jiménez Díaz University Hospital. Universidad Autónoma de Madrid (IIS-FJD, UAM). Madrid, Spain
| | - Beatriz Álvarez Álvarez
- Division of Infectious Diseases. Fundación Jiménez Díaz University Hospital. Universidad Autónoma de Madrid (IIS-FJD, UAM). Madrid, Spain
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Sweet Syndrome, Not so Sweet during an Ulcerative Colitis Flare Especially When You Cannot Eat. Case Rep Gastrointest Med 2021; 2021:9940391. [PMID: 34631178 PMCID: PMC8497118 DOI: 10.1155/2021/9940391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 09/17/2021] [Indexed: 11/26/2022] Open
Abstract
Sweet syndrome is a rare skin condition characterized by painful papules, nodules, or plaques with dense neutrophilic infiltrate in the upper dermis. It has been observed as idiopathic (classical), malignancy-associated, and drug-induced. The pathogenesis is not completely understood, but it is thought to involve hypersensitivity reactions to specific triggers. In some cases the etiology is unclear or may be multifactorial. We present a case of Sweet syndrome secondary to ulcerative colitis flare versus adalimumab re-induction.
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Recognition and Management of Toxic Erythema of Chemotherapy for the Inpatient Dermatologist. CURRENT DERMATOLOGY REPORTS 2021. [DOI: 10.1007/s13671-021-00344-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Böcskei Z, Viinikka E, Dormegny L, Bigaut K, Speeg C. [Paraneoplastic ophthalmopathies]. J Fr Ophtalmol 2021; 45:119-136. [PMID: 34598825 DOI: 10.1016/j.jfo.2021.08.002] [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: 05/31/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
Ocular paraneoplastic syndromes are rare conditions that can affect any part of the eye at any age. Thus, every ophthalmologist should be familiar with their management, as some of them may reveal severe, life-threatening conditions. These consist overwhelmingly of neuro-ophthalmological manifestations, affecting the optic nerve (paraneoplastic optic neuritis), retina (paraneoplastic retinopathy) or neurological pathways generating eye movements (saccadic intrusion, oculomotor palsy, nystagmus...); occasionally, they involve the anterior segment, orbit or uveal tract. As some of these manifestations appear to be quite common and non-specific, any systemic or especially neurologic comorbidities should increase suspicion. Treatment relies first on oncologic management, and then often more targeted therapy for the associated immune involvement.
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Affiliation(s)
- Z Böcskei
- Service d'ophtalmologie, hôpitaux universitaires de Strasbourg, 1, quai Louis-Pasteur, 67000 Strasbourg, France; Service de neurologie, hôpitaux universitaires de Strasbourg, 1, avenue de Molière, 67200 Strasbourg, France.
| | - E Viinikka
- Service d'ophtalmologie, hôpitaux universitaires de Strasbourg, 1, quai Louis-Pasteur, 67000 Strasbourg, France
| | - L Dormegny
- Service d'ophtalmologie, hôpitaux universitaires de Strasbourg, 1, quai Louis-Pasteur, 67000 Strasbourg, France
| | - K Bigaut
- Service de neurologie, hôpitaux universitaires de Strasbourg, 1, avenue de Molière, 67200 Strasbourg, France
| | - C Speeg
- Service d'ophtalmologie, hôpitaux universitaires de Strasbourg, 1, quai Louis-Pasteur, 67000 Strasbourg, France
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Sampaio AL, Bressan AL, Vasconcelos BN, Gripp AC. Skin manifestations associated with systemic diseases - Part I. An Bras Dermatol 2021; 96:655-671. [PMID: 34544638 PMCID: PMC8790165 DOI: 10.1016/j.abd.2021.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/07/2021] [Accepted: 02/15/2021] [Indexed: 11/21/2022] Open
Abstract
The skin demonstrates what is happening in the body in many diseases, as it reflects some internal processes on the surface. In this sense, skin as an organ, goes beyond its protective and barrier functions, as it provides clues for the identification of some systemic diseases. The dermatologist then raises diagnostic hypotheses for conditions related to all systems and refers them to the appropriate specialty. With easy access to examination by trained eyes and biopsies, the skin can present specific or non specific alterations on histopathology. In the first case this combination establishes the diagnosis of the disease itself. Non specific manifestations can occur in a variety of contexts and then histopathology is not specific of a particular disease. This article is divided into two parts that will cover large groups of diseases. In this first part, cutaneous manifestations of the main rheumatologic diseases are described, which are the ones with the greatest interface with dermatology. The authors also talk about vascular manifestations and granulomatous diseases. In the second part, endocrinological, hematological, oncological, cardiovascular, renal, gastrointestinal diseases, pruritus and its causes are discussed, and finally, the dermatological manifestations of SARS-CoV-2 coronavirus infection. The authors’ intention is that, by using direct and easily accessible language, aim to provide practical material for consultation and improvement to all dermatologists who recognize the importance of a comprehensive assessment of their patients.
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Affiliation(s)
- Ana Luisa Sampaio
- Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - Aline Lopes Bressan
- Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Barbara Nader Vasconcelos
- Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Alexandre Carlos Gripp
- Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Paul P, Walker CP, Paul M, Dey D. Sweet's Syndrome in a Patient With Seropositive Rheumatoid Arthritis After Starting Adalimumab: Is Sweet's Syndrome Related to Rheumatoid Arthritis or Is It the Paradoxical Effect of Adalimumab? Cureus 2021; 13:e16804. [PMID: 34513410 PMCID: PMC8407047 DOI: 10.7759/cureus.16804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2021] [Indexed: 01/15/2023] Open
Abstract
Sweet’s syndrome is a rare acute febrile neutrophilic dermatosis accompanied by fever, neutrophilia, and asymmetrical distribution of tender erythematous skin lesions. The underlying biological pathways responsible for this inflammatory skin disorder are not yet clearly established. However, an association with autoimmune disease, neoplasm, and drugs could be indicative of unusual hypersensitivity involving proinflammatory cytokines. There are several case reports indicating an association between Sweet’s syndrome and rheumatoid arthritis (RA). Proinflammatory cytokines are considered to play a vital role in the pathogenesis of both RA and Sweet’s syndrome. Adalimumab works against proinflammatory cytokines and is considered a disease-modifying antirheumatic drug in RA; it is also reported to be effective in refractory Sweet’s syndrome. While adalimumab has been proven to be beneficial in autoimmune disorders and inflammatory conditions, there are also reports of paradoxical development of Sweet’s syndrome with adalimumab. In this report, we present a case of Sweet’s syndrome in a 74-year-old adult patient with a history of seropositive RA who developed Sweet’s syndrome within two months after the initiation of adalimumab therapy.
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Affiliation(s)
- Prodip Paul
- Internal Medicine, Geisinger Community Medical Center, Scranton, USA
| | - Chad P Walker
- Rheumatology, Geisinger Musculoskeletal Institute, Scranton, USA.,Rheumatology, Geisinger Health System, Scranton, USA
| | | | - Dipon Dey
- Epidemiology and Public Health, ZWH Medical Care PC, New York, USA
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Satoh M, Kumekawa M, Yamamoto T. A case of recurrent acute febrile neutrophilic dermatosis in a patient with idiopathic cytopenia of undetermined significance. Clin Exp Dermatol 2021; 47:413-415. [PMID: 34431539 DOI: 10.1111/ced.14906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 08/16/2021] [Accepted: 08/19/2021] [Indexed: 11/27/2022]
Abstract
This is the first report of recurrent acute febrile neutrophilic dermatosis in a patient with idiopathic cytopenia of undetermined significance. The patient progressed to acute myeloid leukaemia 4 months after onset.
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Affiliation(s)
- M Satoh
- Department of Dermatology, Shirakawa Kosei General Hospital, Fukushima, Japan.,Department of Dermatology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - M Kumekawa
- Department of Dermatology, Shirakawa Kosei General Hospital, Fukushima, Japan.,Department of Dermatology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - T Yamamoto
- Department of Dermatology, Fukushima Medical University School of Medicine, Fukushima, Japan
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Alkassis S, Rizwan A, Daoud L, Chi J. Midostaurin-induced Sweet syndrome in a patient with FLT3-ITD-positive AML. BMJ Case Rep 2021; 14:e243615. [PMID: 34417240 PMCID: PMC8381312 DOI: 10.1136/bcr-2021-243615] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2021] [Indexed: 12/30/2022] Open
Abstract
Sweet syndrome (SS), also referred as acute febrile neutrophilic dermatosis, is an inflammatory process characterised by the abrupt appearance of erythematous papules or nodules with predominant neutrophilic infiltration in the dermis. Fever and neutrophilia are common presenting features. However, extracellular manifestations, including ocular and musculoskeletal, may occur. SS is divided into three subtypes: classical (or idiopathic), malignancy associated and drug induced. Medication-induced subtype accounts for up to 26% of cases. In recent years, emerging evidence has showed that SS may also occur in neutropenic patients who underwent induction for acute myeloid leukemia (AML). The identification of FMS-like tyrosine kinase 3 (FLT3) gene mutation in approximately 30% of patients with AML has promoted the targeted therapy with FLT3-internal tandem duplication (ITD) inhibitors. Midostaurin, a recently Food and Drug Administration-approved medication for FLT3-ITD-positive AML, was reported once as cause for SS. We report a midostaurin-induced SS with neutropenia in a patient following induction chemotherapy of AML.
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Affiliation(s)
- Samer Alkassis
- Internal Medicine, Detroit Medical Center, Detroit, Michigan, USA
| | - Aliza Rizwan
- Internal Medicine, Detroit Medical Center, Detroit, Michigan, USA
| | - Lina Daoud
- Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Jie Chi
- Hematology/Oncology, Karmanos Cancer Institute, Detroit, Michigan, USA
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Alvarez-Payares JC, Ramírez-Urrea S, Correa-Parra L, Salazar-Uribe D, Velásquez-López M. Mucocutaneous Manifestations of Inflammatory Bowel Disease. Cureus 2021; 13:e17191. [PMID: 34548985 PMCID: PMC8439267 DOI: 10.7759/cureus.17191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2021] [Indexed: 11/05/2022] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic and incurable disease, of unknown etiology, associated with an unregulated immune response to environmental triggers in a genetically predisposed host. IBD affects mainly the gastrointestinal (GI) tract and includes Crohn's disease (CD) and ulcerative colitis (UC). However, a large percentage of patients may present with extraintestinal manifestations, including mucocutaneous ones (which are the most common) and dermatologic findings, such as erythema nodosum, pyoderma gangrenosum, and aphthous stomatitis (which are the most frequently occurring). According to pathophysiologic mechanisms, mucocutaneous manifestations of IBD are classified into five categories, namely, specific manifestations, associated manifestations, reactive manifestations, adverse effects of IBD therapy, and malabsorption manifestations. Recognizing such manifestations should not be performed only by a dermatologist but also other specialties such as internal medicine, gastroenterology, among others. This is because these manifestations can present before the IBD diagnosis, even in the absence of GI symptoms. Therefore, these skin lesions could be a fundamental tool for the earlier diagnosis of IBD. This review provides a comprehensive overview of the most common cutaneous manifestations of IBD with a focus on their epidemiology, diagnostic criteria, clinical presentation, and available medical treatment.
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Gopee NH, Charlton FG, Hampton P. Sweet syndrome: A retrospective study of 64 cases and proposal of an algorithmic approach to improve investigation and management. SKIN HEALTH AND DISEASE 2021; 1:e23. [PMID: 35664987 PMCID: PMC9060071 DOI: 10.1002/ski2.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/22/2021] [Accepted: 03/01/2021] [Indexed: 11/09/2022]
Abstract
Background Objective Methods Results Conclusion
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Affiliation(s)
- N. H. Gopee
- Department of Dermatology Royal Victoria Infirmary Newcastle upon Tyne UK
| | - F. G. Charlton
- Department of Pathology Royal Victoria Infirmary Newcastle upon Tyne UK
| | - P. J. Hampton
- Department of Dermatology Royal Victoria Infirmary Newcastle upon Tyne UK
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Heil J, Abraham S, Eckardt C, Laske J, Beissert S, Günther C. Bullöses Sweet-Syndrom nach einem Zeckenstich. AKTUELLE DERMATOLOGIE 2021. [DOI: 10.1055/a-1429-9757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ZusammenfassungWir berichten über einen Patienten, der eine Woche nach einem Zeckenstich Fieber und Papulovesikel entwickelte. Eine disseminierte Borrelien-Infektion sowie eine blasenbildende Erkrankung konnte ausgeschlossen werden. Sowohl klinisch als auch histologisch bestätigte sich ein bullöses Sweet-Syndrom, sodass eine systemische Steroidtherapie begonnen wurde. Darunter besserten sich die Beschwerden des Patienten rasch.Die Umfelddiagnostik ergab weder Hinweise auf eine hämatologische Erkrankung noch auf eine Medikamenteneinnahme als Auslöser. Dieser Fall deutet darauf hin, dass auch Arthropodenstiche als Trigger für ein Sweet-Syndrom in Betracht gezogen werden können.
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Affiliation(s)
- J. Heil
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden
| | - S. Abraham
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden
| | - C. Eckardt
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden
| | - J. Laske
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden
| | - S. Beissert
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden
| | - C. Günther
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden
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Vera-Lastra O, Olvera-Acevedo A, Pulido-Díaz N, Quintal-Ramírez MDJ, Ordoñez-González I, Cimé-Aké E, Cruz-Domínguez MP, Medina G. Transformation of a myelodysplastic syndrome to acute myeloid leukemia and concurrent necrotizing sweet syndrome. Dermatol Reports 2021; 13:9017. [PMID: 33824709 PMCID: PMC8018258 DOI: 10.4081/dr.2021.9017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/15/2021] [Indexed: 12/05/2022] Open
Abstract
The Sweet's syndrome, is an inflammatory skin disorder characterized by extensive infiltration of neutrophils in the dermis with extension to the subcutis, known as acute febrile neutrophilic dermatosis. It may occur as a paraneoplastic syndrome. To our knowledge, there are currently few reports about transformation of a myelodysplastic syndrome to acute myeloid leukemia and concurrent necrotizing Sweet syndrome in the literature. Herein we describe an unusual case in a young patient with these characteristics that evolved to a fatal outcome.
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Affiliation(s)
- Olga Vera-Lastra
- Internal Medicine Department, Hospital de Especialidades Centro Médico Nacional La Raza, IMSS, Mexico City
- Universidad Nacional Autónoma de México, Mexico City
| | - Arturo Olvera-Acevedo
- Internal Medicine Department, Hospital de Especialidades Centro Médico Nacional La Raza, IMSS, Mexico City
- Universidad Nacional Autónoma de México, Mexico City
| | - Nancy Pulido-Díaz
- Dermatology Department, Hospital de Especialidades Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City
| | - Marissa de Jesús Quintal-Ramírez
- Pathology Department, Hospital de Especialidades Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City
| | | | - Erik Cimé-Aké
- Internal Medicine Department, Hospital de Especialidades Centro Médico Nacional La Raza, IMSS, Mexico City
- Universidad Nacional Autónoma de México, Mexico City
| | - María Pilar Cruz-Domínguez
- Universidad Nacional Autónoma de México, Mexico City
- Translational Research Unit, Hospital de Especialidades Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City
| | - Gabriela Medina
- Universidad Nacional Autónoma de México, Mexico City
- Research Division, Hospital de Especialidades Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
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Sweet syndrome with bitter outcomes in cervical cancer: A case report. Gynecol Oncol Rep 2021; 36:100749. [PMID: 33850995 PMCID: PMC8039817 DOI: 10.1016/j.gore.2021.100749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/05/2021] [Accepted: 03/10/2021] [Indexed: 12/27/2022] Open
Abstract
Sweet Syndrome is an acute, non-infectious rash with fever and leukocytosis. It is either idiopathic, drug-induced or malignancy-associated (MASS). MASS manifests with leukopenia, anemia, and thrombocytopenia. MASS workup should include prompt punch biopsy and cancer surveillance screening. In cervical cancer, MASS is often an ominous indicator of recurrence or progression.
Background Sweet Syndrome, or acute febrile neutrophilic dermatosis, is a non-infectious, painful rash accompanied by fever, leukocytosis and skin biopsy showing neutrophilic dermal inflammation. It is either idiopathic, drug-induced or malignancy associated (MASS). MASS is uncommon in cervical cancer, and usually signals diagnosis, progression or recurrence. Clinical Course Two months following chemoradiation for stage IIIC2(r) squamous cell carcinoma (SCC) of the cervix, a 55-year-old female developed painful papules and plaques on her left toes. One week later she developed fever and the rash spread to her body. Labs revealed leukopenia and an elevated erythrocyte sedimentation rate. Punch biopsy showed neutrophilic dermal inflammation with papillary dermal edema and was negative for infectious immunohistochemistry. The clinical presentation and histopathological features were consistent with, and met diagnostic criteria for Sweet Syndrome. One month following Sweet Syndrome diagnosis and four months following chemoradiation, positron emission tomography scan revealed recurrence in the pelvic lymph nodes. At this time, she had residual rash on her thighs that responded to oral methylprednisolone. She declined further chemotherapy for recurrent SCC and opted for palliative care. Conclusion We present a rare case of MASS in cervical cancer associated with recurrence two months after chemoradiation.
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Hartog N, Faber W, Frisch A, Bauss J, Bupp CP, Rajasekaran S, Prokop JW. SARS-CoV-2 infection: molecular mechanisms of severe outcomes to suggest therapeutics. Expert Rev Proteomics 2021; 18:105-118. [PMID: 33779460 PMCID: PMC8022340 DOI: 10.1080/14789450.2021.1908894] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/22/2021] [Indexed: 02/06/2023]
Abstract
Introduction:The year 2020 was defined by the 29,903 base pairs of RNA that codes for the SARS-CoV-2 genome. SARS-CoV-2 infects humans to cause COVID-19, spreading from patient-to-patient yet impacts patients very divergently.Areas covered: Within this review, we address the known molecular mechanisms and supporting data for COVID-19 clinical course and pathology, clinical risk factors and molecular signatures, therapeutics of severe COVID-19, and reinfection/vaccination. Literature and published datasets were reviewed using PubMed, Google Scholar, and NCBI SRA tools. The combination of exaggerated cytokine signaling, pneumonia, NETosis, pyroptosis, thrombocytopathy, endotheliopathy, multiple organ dysfunction syndrome (MODS), and acute respiratory distress syndrome (ARDS) create a positive feedback loop of severe damage in patients with COVID-19 that impacts the entire body and may persist for months following infection. Understanding the molecular pathways of severe COVID-19 opens the door for novel therapeutic design. We summarize the current insights into pathology, risk factors, secondary infections, genetics, omics, and drugs being tested to treat severe COVID-19.Expert opinion: A growing level of support suggests the need for stronger integration of biomarkers and precision medicine to guide treatment strategies of severe COVID-19, where each patient has unique outcomes and thus require guided treatment.
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Affiliation(s)
- Nicholas Hartog
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
- Allergy & Immunology, Spectrum Health, Grand Rapids, MI, USA
| | - William Faber
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
- Department of Chemistry, Grand Rapids Community College, Grand Rapids, MI, USA
| | - Austin Frisch
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Jacob Bauss
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Caleb P Bupp
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
- Spectrum Health Medical Genetics, Grand Rapids, MI, USA
| | - Surender Rajasekaran
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
- Pediatric Intensive Care Unit, Helen DeVos Children’s Hospital, Grand Rapids, MI, USA
- Office of Research, Office of Research, Spectrum Health, Grand Rapids, MI, USA
| | - Jeremy W Prokop
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
- Department of Pharmacology and Toxicology, Michigan State University, East Lansing, MI, USA
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Panigrahi A, Biswas SK, Sil A, Bhanja DB. Neutrophilic Dermatosis of the Hands with Palmar Involvement and Predominant Lymphomononuclear Cell Infiltration. Indian J Dermatol 2021; 66:191-194. [PMID: 34188277 PMCID: PMC8208261 DOI: 10.4103/ijd.ijd_218_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Neutrophilic dermatosis of the hands (NDH) is a rare localized acral variant of Sweet syndrome. NDH predominantly involves the dorsal hands with characteristic dense dermal neutrophilic infiltrate with an upper dermal edema observed on histopathology. Unusual findings like palmar involvement and predominant lymphomononuclear dermal infiltration in our case with NDH, makes it an interesting read.
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Affiliation(s)
- Avik Panigrahi
- Department of Dermatology, Venereology, and Leprosy, R.G. Kar Medical College, Kolkata, West Bengal, India
| | - Surajit K Biswas
- Department of Dermatology, Venereology, and Leprosy, R.G. Kar Medical College, Kolkata, West Bengal, India
| | - Abheek Sil
- Department of Dermatology, Venereology, and Leprosy, R.G. Kar Medical College, Kolkata, West Bengal, India
| | - Dibyendu B Bhanja
- Department of Dermatology, Venereology, and Leprosy, R.G. Kar Medical College, Kolkata, West Bengal, India
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Graça-Santos L, Kieselova K, Montenegro-Sá F, Guardado J, Morais J. Myocardial Involvement in Sweet Syndrome: A Rare Finding in a Rare Condition. Arq Bras Cardiol 2020; 115:6-9. [PMID: 32935756 PMCID: PMC8386950 DOI: 10.36660/abc.20190249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 08/18/2019] [Indexed: 12/21/2022] Open
Affiliation(s)
- Luís Graça-Santos
- Departamento de Cardiologia, Centro Hospitalar de Leiria, Leiria - Portugal
| | - Katarina Kieselova
- Departamento de Dermatologia, Centro Hospitalar de Leiria, Leiria - Portugal
| | | | - Joana Guardado
- Departamento de Dermatologia, Centro Hospitalar de Leiria, Leiria - Portugal
| | - João Morais
- Departamento de Dermatologia, Centro Hospitalar de Leiria, Leiria - Portugal
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de Lima ÍMF, Ferraz CE, Gonçalves de Lima-Neto R, Takano DM. Case Report: Sweet Syndrome in Patients with Sporotrichosis: A 10-Case Series. Am J Trop Med Hyg 2020; 103:2533-2538. [PMID: 33025874 DOI: 10.4269/ajtmh.20-0579] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Human sporotrichosis is an emerging disease caused by fungi of the genus Sporothrix, distributed worldwide, but mostly in tropical and subtropical regions. This disease is caused by traumatic inoculation of contaminated material (either animal or vegetal in origin) into the skin. Sporotrichosis cases caused by zoonotic transmission through felines have significantly increased over the last 20 years in Brazil. There is a spectrum of clinical outcomes, from classical lymphocutaneous and fixed forms to disseminated manifestations and extracutaneous lesions; however, hypersensitivity reactions related to sporotrichosis, including Sweet syndrome (acute febrile neutrophilic dermatoses), are uncommon. In Brazil, Sporothrix brasiliensis is repeatedly associated with feline infection and has consistently shown higher virulence, tendency to escalate to outbreaks or epidemics, and development of atypical forms. Therefore, the objective of the present study was to report the cases of 10 patients with sporotrichosis infected by S. brasiliensis species who developed Sweet syndrome to alert this association, especially in endemic areas.
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Affiliation(s)
| | - Cláudia Elise Ferraz
- 2Hospital of Clinics, Federal University of Pernambuco, Recife, Brazil.,3Department of Tropical Medicine, Federal University of Pernambuco, Recife, Brazil
| | - Reginaldo Gonçalves de Lima-Neto
- 2Hospital of Clinics, Federal University of Pernambuco, Recife, Brazil.,3Department of Tropical Medicine, Federal University of Pernambuco, Recife, Brazil
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Ferdjallah A, Boull CL, Stefanski H, Ebens CL. A diffuse rash in a patient after allogeneic hematopoietic stem cell transplant for AML. Clin Case Rep 2020; 8:3625-3627. [PMID: 33364009 PMCID: PMC7752433 DOI: 10.1002/ccr3.3306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/31/2020] [Accepted: 08/12/2020] [Indexed: 11/10/2022] Open
Abstract
Sweet's syndrome associated with relapse of leukemia suggests abnormal neutrophil response to transformation of dysfunctional leukemia blast cells, and hence, relapse should be excluded in similar clinical situation.
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Affiliation(s)
- Asmaa Ferdjallah
- Division of Hematology and OncologyUniversity of Minnesota Masonic Children’s HospitalMinneapolisMinnesotaUSA
| | - Christina L. Boull
- Division of Pediatric DermatologyUniversity of Minnesota Masonic Children’s HospitalMinneapolisMinnesotaUSA
| | - Heather Stefanski
- Division of Blood and Marrow TransplantationDepartment of PediatricsUniversity of Minnesota Masonic Children’s HospitalMinneapolisMinnesotaUSA
| | - Christen L. Ebens
- Division of Blood and Marrow TransplantationDepartment of PediatricsUniversity of Minnesota Masonic Children’s HospitalMinneapolisMinnesotaUSA
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Maller B, Bigness A, Moiño D, Greene J. Sweet's syndrome associated with hematological malignancies. Leuk Res 2020; 99:106461. [PMID: 33099235 DOI: 10.1016/j.leukres.2020.106461] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/09/2020] [Accepted: 10/12/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Sweet's syndrome, or acute febrile neutrophilic dermatosis, is often mistaken for a skin infection given its similar clinical presentation. OBJECTIVE To describe the clinical presentations and management of a rare dermatologic condition associated with hematological malignancies. METHODS Case series; Chart review of patients at Moffitt Cancer Center between 2017 and 2020. RESULTS The subjects are a 79 year-old man (Patient 1) with Myelodysplastic Syndrome (MDS), a 66 year-old woman (Patient 2) with Acute Myeloid Leukemia (AML), a 56 year-old man (Patient 3) with AML, and a 69 year-old man (Patient 4) with MDS. Patient 1 was initially misdiagnosed with neutropenic fever. Patient 2 was incidentally discovered to have erythematous skin lesions prior to initiating chemotherapy. Before starting second line chemotherapy, patient 3 developed pathergy at the site of a PICC line. Patient 4 developed erythema around a newly placed port before initiating chemotherapy. Only patients 1 and 3 received glucocorticoids. Patients 2, 3, and 4 were able to initiate chemotherapy without further complications. LIMITATIONS Heterogeneity of subjects in terms of prognostic factors, stage at diagnosis, and treatment strategies. CONCLUSION Early recognition and treatment of malignancy-associated Sweet's syndrome is imperative to limit patient morbidity and expeditiously provide anti-cancer treatments.
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Affiliation(s)
- Bradley Maller
- VCU Health, Department of Internal Medicine, 1101 E Marshall St Sanger Hall Suite 1-030 Richmond, VA, 23298, United States.
| | - Alec Bigness
- USF Health Morsani College of Medicine, 12901 Bruce B Downs Blvd Tampa, FL, 33612, United States.
| | - Daniela Moiño
- USF Health Morsani College of Medicine, 12901 Bruce B Downs Blvd Tampa, FL, 33612, United States.
| | - John Greene
- Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr Tampa, FL, 33612, United States.
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Korkmaz M, Eryılmaz MK, Karaağaç M, Demirkıran A, Araz M, Artaç M. Pemetrexed-induced Sweet Syndrome: First case report in the medical literature. J Oncol Pharm Pract 2020; 27:1307-1310. [PMID: 33028131 DOI: 10.1177/1078155220963178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Sweet Syndrome, also known as acute febrile neutrophilic dermatosis, is a rare inflammatory disease characterized by the sudden emergence of painful, edematous, and erythematous papules, plaques, or nodules on the skin, which usually fully responsive to systemic corticosteroids. Skin lesions are often accompanied by fever and leukocytosis. Here we present a case of Sweet Syndrome caused by pemetrexed in metastatic lung adenocarcinoma. CASE REPORT A 52-year-old patient with metastatic lung adenocarcinoma received multiple lines of chemotherapy. The patient presented with extensive skin lesions after performing of pemetrexed chemotherapy. He had a fever and elevations in blood levels of C-reactive protein (CRP), sedimentation, leucocytes, and neutrophils. Neutrophil predominant perivascular and interstitial dermatitis, focal micropustule formation, and severe neutrophilic dermatosis were reported in skin biopsy. Topical steroid and oral antihistamine treatment were started as initial treatment.Discussion and conclusions: Cutaneous side effects related to pemetrexed are often reported as 'skin rash,' which is a non-specific term. Therefore, the diagnosis of Sweet Syndrome must be confirmed by skin biopsy. It is essential to exclude the presence of an infection and medication history. Recovery in drug-induced Sweet Syndrome occurs after the drug that caused it was discontinued. Systemic corticosteroids are the first-line treatment for most cases.
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Affiliation(s)
- Mustafa Korkmaz
- Department of Medical Oncology, Necmettin Erbakan University School of Medicine, Konya, Turkey
| | - Melek Karakurt Eryılmaz
- Department of Medical Oncology, Necmettin Erbakan University School of Medicine, Konya, Turkey
| | - Mustafa Karaağaç
- Department of Medical Oncology, Necmettin Erbakan University School of Medicine, Konya, Turkey
| | - Aykut Demirkıran
- Department of Medical Oncology, Necmettin Erbakan University School of Medicine, Konya, Turkey
| | - Murat Araz
- Department of Medical Oncology, Necmettin Erbakan University School of Medicine, Konya, Turkey
| | - Mehmet Artaç
- Department of Medical Oncology, Necmettin Erbakan University School of Medicine, Konya, Turkey
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Hodl I, Bosch P, Dreo B, Stradner MH. Case Report: Extensive Phosphorylation of Interleukin-1 Receptor-Associated Kinase 4 in a Patient With Schnitzler Syndrome. Front Immunol 2020; 11:576200. [PMID: 33123160 PMCID: PMC7569524 DOI: 10.3389/fimmu.2020.576200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/07/2020] [Indexed: 11/13/2022] Open
Abstract
Schnitzler syndrome (SchS) is a rare autoinflammatory disease, characterized by urticarial rash, recurrent fever, osteo-articular pain/arthritis with bone condensation, and monoclonal gammopathy. Diagnosis may be difficult due to overlapping signs with other diseases. Here, we describe the case of a 62-year-old man with SchS, who was initially misdiagnosed with multicentric Castleman disease (MCD). As excessive release of IL-6 is characteristic of MCD, in contrast to IL-1 in SchS, we measured the phosphorylation of intracellular signaling proteins of the respective pathways by flow cytometry. We found a distinct increase of phosphorylated IRAK-4 in our patient's B cells and monocytes while phosphorylation of STAT-3 was low, suggesting predominant IL-1 signaling. In accordance with these results and the classification criteria, we established the diagnosis of SchS instead of MCD and commenced therapy with the IL-1 receptor antagonist anakinra. We observed a rapid remission of signs accompanied by a reduction of phosphorylated IRAK-4 to normal levels. In conclusion, we propose phosphorylated IRAK-4 in B cells and monocytes as a potential marker for diagnosis of SchS and for treatment response to IL-1 blockade.
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Affiliation(s)
| | | | | | - Martin H. Stradner
- Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Navarro-Triviño FJ, Pérez-López I, Ruíz-Villaverde R. Doxycycline, an antibiotic or an anti-inflammatory agent? The Most Common uses in dermatology. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2019.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Mishra AV, Fung AT, Pollmann AS, Henderson R, Shields C, Gupta RR. Relentlessly Progressive Sweet Syndrome of the Eye with Scleritis and Choroidal Infiltration. Ocul Immunol Inflamm 2020; 30:90-94. [PMID: 32813581 DOI: 10.1080/09273948.2020.1788611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To describe a case of Sweet syndrome, a dermatologic inflammatory disease, with progressive, unrelenting ocular findings. METHODS Case report. RESULTS A 73-year-old male was evaluated with a six-month history of Sweet syndrome, manifesting as cutaneous erythematous edematous papules on the dorsal arms and shins and confirmed with biopsy demonstrating neutrophil infiltration with nuclei fragmentation and lack of vasculitis. He initially noted a unilateral red eye with ocular pain and was found to have scleritis and choroidal infiltration. The patient's ocular disease progressed despite treatment with systemic corticosteroids, intraocular Ozurdex ®, systemic dapsone, and subtenons triamcinolone. Systemic evaluation was negative for malignancy or other inflammatory syndromes. Following 7 months of non-manageable ocular pain enucleation was offered to the patient, but he declined. CONCLUSION Sweet syndrome, a dermatologic condition, can be associated with unilateral scleritis and choroidal infiltration that are relentlessly progressive despite maximal systemic and ocular corticosteroid therapy.
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Affiliation(s)
- Amit V Mishra
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Adrian T Fung
- Westmead and Central (Save Sight Institute) Clinical Schools, Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, Australia.,Department of Ophthalmology, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Andre S Pollmann
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rosemary Henderson
- Department of Pathology, Queen Elizabeth Hospital, Charlottetown, Prince Edward Island, Canada
| | - Carol Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - R Rishi Gupta
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Fonseca GSD, Pinto AFDA, Silveira SCF, Silva JHDAE, Silva VAD, Oliveira LRD. Sweet's syndrome during induction chemotherapy for acute myeloid leukemia - case report and mini review. Hematol Transfus Cell Ther 2020; 43:374-376. [PMID: 32682782 PMCID: PMC8446258 DOI: 10.1016/j.htct.2020.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 04/14/2020] [Accepted: 05/15/2020] [Indexed: 10/25/2022] Open
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