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Zeng H, Ma Y, He X, Cai S, Chen P, Chen Y, Luo H. Characteristics and Follow-Up of Organizing Pneumonia Associated with Haematological Malignancies. Int J Gen Med 2022; 15:301-310. [PMID: 35027840 PMCID: PMC8752074 DOI: 10.2147/ijgm.s337321] [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: 09/02/2021] [Accepted: 12/23/2021] [Indexed: 11/23/2022] Open
Abstract
Background Organizing pneumonia (OP) is a secondary process in many diseases. Due to its low incidence and indistinct symptoms, there is limited information on OP associated with haematological malignancies. Therefore, the aim of this study was to discuss the characteristics and prognosis of OP associated with haematological malignancies. Methods We observed and analysed pathologically confirmed OP cases associated with haematological malignancies in a hospital record database and excluded cases of OP with known causes, including chemotherapy, radiotherapy, targeted therapy, transplantation and infection. Results There were five patients with OP underlying only haematological malignancies, including one case each of the following: myelodysplastic syndrome, acute myelogenous leukaemia, multiple myeloma, aplastic anaemia, and T cell lymphoma. Radiological findings did not show a distinct pattern, and two cases mimicked pulmonary aspergillosis with ground-glass opacity (GGO). The diagnosis of OP was confirmed by minimal invasive biopsy. Although all patients developed severe cases, steroids yielded favourable outcomes. Conclusion This study demonstrates that haematological malignancies may be a cause of OP and that minimal invasive biopsy may be an effective and safe method to confirm the diagnosis. Although OP associated with haematological malignancies may more frequently develop into severe cases, the OP lesions were steroid-responsive during follow-up.
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Affiliation(s)
- Huihui Zeng
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Diseases, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine Changsha, Hunan, People's Republic of China
| | - Yiming Ma
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Diseases, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine Changsha, Hunan, People's Republic of China
| | - Xue He
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Diseases, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine Changsha, Hunan, People's Republic of China
| | - Shan Cai
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Diseases, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine Changsha, Hunan, People's Republic of China
| | - Ping Chen
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Diseases, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine Changsha, Hunan, People's Republic of China
| | - Yan Chen
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Diseases, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine Changsha, Hunan, People's Republic of China
| | - Hong Luo
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Diseases, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine Changsha, Hunan, People's Republic of China
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2
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Bizymi N, Pitsidianakis G, Ierodiakonou D, Stathakis G, Vasarmidi E, Hiraki S, Bolaki M, Karagiannis K, Fanaridis M, Liopyrakis K, Marinos L, Xilouri I, Antoniou KM, Tzanakis N. Case Report: Diagnosis of Myelodysplastic Syndrome in a 72-Year-Old Female With Interstitial Lung Disease. Front Med (Lausanne) 2021; 8:673573. [PMID: 34434942 PMCID: PMC8380831 DOI: 10.3389/fmed.2021.673573] [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: 02/27/2021] [Accepted: 06/30/2021] [Indexed: 11/13/2022] Open
Abstract
Acute fibrinous and organizing pneumonia (AFOP) is an entity that can be secondary to various conditions leading to lung injury, such as infections, malignancies, and various autoimmune conditions or idiopathic interstitial lung disease, when no obvious underlying cause is identified. Myelodysplastic syndromes (MDS), on the other hand, are a spectrum of clonal myeloid disorders, with a higher risk of acute leukemia, characterized by ineffective bone marrow (BM) hematopoiesis and, thus, peripheral blood (PB) cytopenias. Immune deregulation is thought to take part in the pathophysiology of the disease, including abnormal T and/or B cell responses, innate immunity, and cytokine expression. In the literature, there are a few case reports of patients with MDS that have presented pulmonary infiltrates and were diagnosed as having AFOP or organizing pneumonia (OP). It is rare, though, to have isolated pulmonary infiltrates without Sweet's syndrome or even the pulmonary infiltrates to precede the diagnosis and treatment of MDS, which was our case. We present a 72-year-old female developing new lung infiltrates refractory to antibiotic treatment that responded well to corticosteroids and was histologically described as having OP. The treatment was gradually successfully switched to mycophenolate mofetil (MMF). The patient was later diagnosed with MDS. This interesting case report suggests firstly that a diagnosis of AFOP or OP should alert the clinician to search for an underlying cause including MDS and vice versa, the use of systemic steroids should not be postponed, and, finally, that MMF can successfully be used in these patients.
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Affiliation(s)
- Nikoleta Bizymi
- Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece.,Hemopoiesis Research Laboratory, School of Medicine, University of Crete and Department of Hematology, University Hospital of Heraklion, Heraklion, Greece
| | | | - Despo Ierodiakonou
- Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece.,Department of Primary care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Georgios Stathakis
- Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Eirini Vasarmidi
- Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Stavroti Hiraki
- Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Maria Bolaki
- Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece
| | | | - Michail Fanaridis
- Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Konstantinos Liopyrakis
- Hemopoiesis Research Laboratory, School of Medicine, University of Crete and Department of Hematology, University Hospital of Heraklion, Heraklion, Greece
| | - Leonidas Marinos
- Department of Hemopathology, Evangelismos General Hospital, Athens, Greece
| | - Irini Xilouri
- Hemopoiesis Research Laboratory, School of Medicine, University of Crete and Department of Hematology, University Hospital of Heraklion, Heraklion, Greece
| | - Katerina M Antoniou
- Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Nikolaos Tzanakis
- Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece
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3
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Heath MS, Ortega-Loayza AG. Insights Into the Pathogenesis of Sweet's Syndrome. Front Immunol 2019; 10:414. [PMID: 30930894 PMCID: PMC6424218 DOI: 10.3389/fimmu.2019.00414] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 02/15/2019] [Indexed: 12/15/2022] Open
Abstract
Sweet's syndrome, also known as Acute Febrile Neutrophilic Dermatosis, is a rare inflammatory condition. It is considered to be the prototype disease of neutrophilic dermatoses, and presents with acute onset dermal neutrophilic lesions, leukocytosis, and pyrexia. Several variants have been described both clinically and histopathologically. Classifications include classic Sweet's syndrome, malignancy associated, and drug induced. The cellular and molecular mechanisms involved in Sweet's syndrome have been difficult to elucidate due to the large variety of conditions leading to a common clinical presentation. The exact pathogenesis of Sweet's syndrome is unclear; however, new discoveries have shed light on the role of inflammatory signaling, disease induction, and relationship with malignancy. These findings include an improved understanding of inflammasome activation, malignant transformation into dermal infiltrating neutrophils, and genetic contributions. Continued investigations into effective treatments and targeted therapy will benefit patients and improve our molecular understanding of inflammatory diseases, including Sweet's syndrome.
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Affiliation(s)
- Michael S Heath
- Oregon Health and Science University, Department of Dermatology, Portland, OR, United States
| | - Alex G Ortega-Loayza
- Oregon Health and Science University, Department of Dermatology, Portland, OR, United States
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4
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Kazmi SM, Pemmaraju N, Patel KP, Cohen PR, Daver N, Tran KM, Ravandi F, Duvic M, Garcia-Manero G, Pierce S, Nazha A, Borthakur G, Kantarjian H, Cortes J. Characteristics of Sweet Syndrome in patients with acute myeloid leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2014; 15:358-363. [PMID: 25630528 DOI: 10.1016/j.clml.2014.12.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 12/16/2014] [Accepted: 12/16/2014] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Sweet syndrome (SS) is associated with hematologic malignancies including acute myeloid leukemia (AML). PATIENTS AND METHODS Records of patients with AML treated at our institution were reviewed to identify those with SS. Patient characteristics, laboratory values, and cytogenetic and molecular abnormalities were retrospectively reviewed. RESULTS We identified 21 of 2178 (1%) AML patients who demonstrated clinical signs and symptoms, and histological features consistent with SS. Eleven patients (52%) were classified as AML with myelodysplasia-related features and 3 patients had therapy-related AML. Three patients had received treatment with granulocyte colony stimulation factor, 1 patient liposomal all-trans-retinoic acid, and 2 patients received hypomethylating agents before development of SS. Cytogenetic analysis revealed diploid karyotype in 7 patients (33%); -5/del(5q) in 8 patients (38%): 3 patients had -5/del(5q) as the sole abnormality and 5 patients had -5/del(5q) as part of complex cytogenetics; and complex cytogenetics in 5 patients (24%). Gene mutations in FMS-related tyrosine kinase-3 (FLT3) gene were identified in 7 of 18 evaluable patients (39%), including FLT3-internal tandem duplication in 4 patients and FLT3-D835 tyrosine kinase domain mutation in 3 patients. CONCLUSION SS occurs in 1% of AML patients; -5/del(5q) karyotype, FLT3 mutations, and AML with myelodysplasia-related features were more frequent among patients with SS.
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Affiliation(s)
- Syed M Kazmi
- Department of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Naveen Pemmaraju
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Keyur P Patel
- Department of Hematopathology, University of Texas MD Anderson Cancer Center, TX, USA
| | - Philip R Cohen
- Division of Dermatology, University of California San Diego, San Diego, CA, USA
| | - Naval Daver
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kathy M Tran
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Farhad Ravandi
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Madeleine Duvic
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Sherry Pierce
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Aziz Nazha
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gautam Borthakur
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hagop Kantarjian
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jorge Cortes
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Tzelepis E, Kampolis CF, Vlachadami I, Moschovi M, Alamani M, Kaltsas G. Cryptogenic organizing pneumonia in Sweet's syndrome: case report and review of the literature. CLINICAL RESPIRATORY JOURNAL 2014; 10:250-4. [PMID: 25196175 DOI: 10.1111/crj.12206] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 07/22/2014] [Accepted: 08/27/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Sweet's syndrome or acute febrile neutrophilic dermatosis is characterized by fever, leukocytosis and tender erythematous plaques, which show infiltration by mature neutrophils on histological examination. Pulmonary involvement is rare in Sweet's syndrome. METHOD We describe the case of a 17-year-old man with a myelodysplastic syndrome following therapy for Hodgkin's lymphoma who developed Sweet's syndrome and cryptogenic organizing pneumonia. In addition, we conducted a review of the related English literature. RESULTS Literature review yielded six similar reports of biopsy-proven cryptogenic organizing pneumonia associated with Sweet's syndrome. We present the clinical and laboratory characteristics, as well as the response to treatment, of all cases of cryptogenic organizing pneumonia reported in patients with Sweet's syndrome. CONCLUSIONS Cryptogenic organizing pneumonia is a rare manifestation of Sweet's syndrome, which may be complicated by respiratory failure. Prompt treatment with corticosteroids usually leads to clinical and radiographic improvement.
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Affiliation(s)
- Elias Tzelepis
- Department of Pathophysiology, 'Laiko' Hospital, University of Athens Medical School, Athens, Greece
| | - Christos F Kampolis
- Department of Pathophysiology, 'Laiko' Hospital, University of Athens Medical School, Athens, Greece
| | - Ioanna Vlachadami
- Department of Pathophysiology, 'Laiko' Hospital, University of Athens Medical School, Athens, Greece
| | - Maria Moschovi
- Department of Pediatrics, University of Athens Medical School, Athens, Greece
| | - Maria Alamani
- Department of Pathology, Henry Dunant Hospital, Athens, Greece
| | - Gregory Kaltsas
- Department of Pathophysiology, 'Laiko' Hospital, University of Athens Medical School, Athens, Greece
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6
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Li Y, Ai M, Yang WB, Li X. Vital organ involvement in Sweet's syndrome with myelodysplastic syndrome: a case report and literature review. Int J Dermatol 2014; 54:1303-8. [PMID: 24697510 DOI: 10.1111/ijd.12280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 02/21/2013] [Accepted: 03/17/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Yun Li
- Department of Dermatology; 181st Hospital of the Chinese People's Liberation Army; Guilin China
| | - Mi Ai
- Department of Dermatology; 181st Hospital of the Chinese People's Liberation Army; Guilin China
| | - Wei-bing Yang
- Department of Dermatology; 181st Hospital of the Chinese People's Liberation Army; Guilin China
| | - Xin Li
- Department of Dermatology; 181st Hospital of the Chinese People's Liberation Army; Guilin China
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7
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Fernandez-Bussy S, Labarca G, Cabello F, Cabello H, Folch E, Majid A. Sweet's syndrome with pulmonary involvement: Case report and literature review. Respir Med Case Rep 2012; 6:16-9. [PMID: 26029596 PMCID: PMC3920571 DOI: 10.1016/j.rmcr.2012.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 08/25/2012] [Indexed: 11/15/2022] Open
Abstract
A 74 year old female presented with fever, associated with papules and plaque in her upper and lower extremities. Exams revealed blood leukocytosis and a positive urine culture. Antibiotic therapy was initiated with no clinical response. After 1 week, chest X-ray showed right upper lobe alveolar infiltrate. A skin biopsy of the lesion showed infiltration by neutrophils, consistent with Sweet's Syndrome. Patient's condition progressively worsened, requiring oxygentherapy. Bronchoscopy and bronchoalveolar lavage were normal, transbronchial biopsies suggested lung involvement of Sweet 's syndrome. Antibiotic therapy was stopped. Corticosteroid were started. Therapy resulted in rapid clinical and radiological improvement.
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Affiliation(s)
- S Fernandez-Bussy
- Interventional Pulmonology, Clinica Alemana-Universidad del Desarrollo, Santiago, Manquehue Norte 1410, Chile
| | - G Labarca
- Clinica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - F Cabello
- Universidad de Valparaiso, Santiago, Chile
| | - H Cabello
- Interventional Pulmonology, Clinica Alemana-Universidad del Desarrollo, Santiago, Manquehue Norte 1410, Chile
| | - E Folch
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - A Majid
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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8
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Epler GR. Bronchiolitis obliterans organizing pneumonia, 25 years: a variety of causes, but what are the treatment options? Expert Rev Respir Med 2011; 5:353-61. [PMID: 21702658 DOI: 10.1586/ers.11.19] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Bronchiolitis obliterans organizing pneumonia is an inflammatory lung disease involving the distal bronchioles, respiratory bronchioles, bronchiolar ducts and alveoli. Its cause is generally unknown, but there are several known causes and associated systemic diseases. The clinical features include cough, shortness of breath and bilateral crackles. The vital capacity is slightly decreased, and the diffusing capacity is moderately to severely decreased. The high-resolution chest CT scan shows bilateral ground-glass opacities with air bronchograms and triangular, pleura-based opacities. Corticosteroid therapy is the best treatment option. The outcome of patients suffering from bronchiolitis obliterans organizing pneumonia is good, as up to 80% of individuals will be cured.
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Affiliation(s)
- Gary R Epler
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
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9
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Watanabe T, Nakashima K, Shindo M, Yoshida Y, Yamamoto O. Multiorgan involvement in Sweet’s syndrome. Clin Exp Dermatol 2009; 34:e343-4. [DOI: 10.1111/j.1365-2230.2009.03290.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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10
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Stem cell transplant for myelodysplastic syndrome-associated histiocytoid sweet's syndrome in a patient with arthritis and myalgias. ACTA ACUST UNITED AC 2008; 59:1832-4. [DOI: 10.1002/art.24061] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Chatham-Stephens K, Devere T, Guzman-Cottrill J, Kurre P. Metachronous manifestations of Sweet's syndrome in a neutropenic patient with Fanconi anemia. Pediatr Blood Cancer 2008; 51:128-30. [PMID: 18300309 DOI: 10.1002/pbc.21538] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Sweet's syndrome (SS) is an acute, febrile neutrophilic dermatosis that frequently presents with leukocytosis and erythematous plaques. Lesions show neutrophilic infiltration of the dermis and rarely other organs. We report the case of an adolescent male with chronic pancytopenia secondary to Fanconi anemia (FA) who presented with acute respiratory distress. Despite an exhaustive and ultimately unrevealing work-up, the diagnosis of pulmonary SS was not made until he developed characteristic cutaneous lesions 4 months later. Comprehensive review of pathological specimens revealed metachronous SS manifestations with infiltrates in lung parenchyma, dermis, and subcutis in this neutropenic patient.
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