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Muralidharan S, Mariano AT, Joshi D, Andrews TE, Liu S, Basha A, Huynh N. A Rare Case of Drug-Induced Sweet Syndrome After Pembrolizumab Therapy. Cureus 2024; 16:e62027. [PMID: 38859947 PMCID: PMC11163154 DOI: 10.7759/cureus.62027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2024] [Indexed: 06/12/2024] Open
Abstract
Sweet syndrome is an uncommon inflammatory disorder characterized by the abrupt appearance of painful, erythematous papules, plaques, or nodules on the skin. Fever and leukocytosis frequently accompany the cutaneous lesions. In addition, involvement of the eyes, musculoskeletal system, and internal organs may occur. Sweet syndrome has been associated with a broad range of disorders. There are three subtypes: classical Sweet syndrome, malignancy-associated Sweet syndrome, and drug-induced Sweet syndrome. Classical Sweet syndrome is not associated with malignancy or drugs. It is essentially associated with an upper respiratory infection, gastrointestinal infection, inflammatory bowel disease, and pregnancy. Malignancy-associated Sweet syndrome is associated with hematologic malignancy more than solid malignancy, most commonly with acute myeloid leukemia. Drug-induced Sweet syndrome usually develops approximately two weeks after drug exposure, in patients who lack a prior history of exposure to the inciting drug. Here we are discussing our patient, a 68-year-old male who presented eight weeks after starting chemotherapy with pemetrexed, carboplatin, and pembrolizumab for left lung adenocarcinoma with macular rash. On further investigation with biopsy was found to have neutrophilic dermatitis, hence being diagnosed with drug-induced Sweet syndrome. Histopathology revealed a dermis with infiltration of neutrophils with lekocytoclasia.
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Affiliation(s)
| | | | - Dhruv Joshi
- Internal Medicine, Riverside Medical Center, Kankakee, USA
| | | | - Seban Liu
- Cardiology, Riverside Medical Center, Kankakee, USA
| | - Ahsan Basha
- Oncology, Riverside Medical Center, Kankakee, USA
| | - Nha Huynh
- Cardiology, Riverside Medical Center, Kankakee, USA
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Bumbăcea RS, Udrea MR, Ali S, Bojincă VC. Balancing Benefits and Risks: A Literature Review on Hypersensitivity Reactions to Human G-CSF (Granulocyte Colony-Stimulating Factor). Int J Mol Sci 2024; 25:4807. [PMID: 38732026 PMCID: PMC11084733 DOI: 10.3390/ijms25094807] [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: 02/23/2024] [Revised: 04/20/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
Human granulocyte colony-stimulating factor (G-CSF) is a granulopoietic growth factor used in the treatment of neutropenia following chemotherapy, myeloablative treatment, or healthy donors preparing for allogeneic transplantation. Few hypersensitivity reactions (HRs) have been reported, and its true prevalence is unknown. We aimed to systematically characterize G-CSF-induced HRs while including a comprehensive list of adverse reactions. We reviewed articles published before January 2024 by searching in the PubMed, Embase, Cochrane Library, and Web of Science databases using a combination of the keywords listed, selected the ones needed, and extracted relevant data. The search resulted in 68 entries, 17 relevant to our study and 7 others found from manually searching bibliographic sources. A total of 40 cases of G-CSF-induced HR were described and classified as immediate (29) or delayed (11). Immediate ones were mostly caused by filgrastim (13 minimum), with at least 9 being grade 5 on the WAO anaphylaxis scale. Delayed reactions were mostly maculopapular exanthemas and allowed for the continuation of G-CSF. Reactions after first exposure frequently appeared and were present in at least 11 of the 40 cases. Only five desensitization protocols have been found concerning the topic at hand in the analyzed data. We believe this study brings to light the research interest in this topic that could benefit from further exploration, and propose regular updating to include the most recently published evidence.
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Affiliation(s)
- Roxana Silvia Bumbăcea
- Allergology Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.S.B.); (S.A.)
- Department of Allergology and Clinical Immunology, “Carol Davila” Nephrology Clinical Hospital, 010731 Bucharest, Romania
| | - Mihaela Ruxandra Udrea
- Allergology Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.S.B.); (S.A.)
- Department of Allergology and Clinical Immunology, “Carol Davila” Nephrology Clinical Hospital, 010731 Bucharest, Romania
| | - Selda Ali
- Allergology Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.S.B.); (S.A.)
- Department of Allergology and Clinical Immunology, “Carol Davila” Nephrology Clinical Hospital, 010731 Bucharest, Romania
| | - Violeta Claudia Bojincă
- Clinical Department 5, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Internal Medicine and Rheumatology, “Sfânta Maria” Hospital, 011172 Bucharest, Romania
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Yu KQ, Li HX, Wu J. Suspected coexistence of perianal necrotizing sweet syndrome in chronic myelomonocytic leukemia: A case report. World J Gastrointest Surg 2024; 16:1176-1183. [PMID: 38690058 PMCID: PMC11056667 DOI: 10.4240/wjgs.v16.i4.1176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/02/2024] [Accepted: 03/11/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Chronic myelomonocytic leukemia (CMML) complicated with Sweet syndrome (SS) is a rare hematological neoplasm. However, cases of concomitant development of perianal necrotizing SS (NSS) have not been reported. CASE SUMMARY We report a case of a 49-year-old male patient who underwent sequential procedures for hemorrhoids and perianal abscess. He developed postoperative incision infection and was referred to the department where the authors work. Initially, perianal necrotizing fasciitis secondary to incision infection after perianal abscess surgery was suspected. Despite receiving antibiotic therapy and undergoing surgical debridement, deeper necrotic areas formed in the patient's perianal wounds, accompanied by persistent high fever. Blood and fungal cultures yielded negative results. The final diagnosis was corrected to be CMML with suspected concomitant perianal NSS. CONCLUSION CMML with perianal NSS is a rare condition, often misdiagnosed as perianal abscess or perianal necrotizing fasciitis. Conventional antibiotic therapy and surgical debridement are ineffective in managing this condition.
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Affiliation(s)
- Ke-Qiang Yu
- Clinical Medicine School, Chengdu University of Chinese Medicine, Chengdu 610072, Sichuan Province, China
- Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Hui-Xiang Li
- Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jing Wu
- Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Bagos-Estevez AG, Moore S, Turner L, Baldwin B. A Case of Bullous Sweet's Syndrome Associated With Esophageal Adenocarcinoma. Cureus 2024; 16:e52954. [PMID: 38406046 PMCID: PMC10894071 DOI: 10.7759/cureus.52954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 02/27/2024] Open
Abstract
Sweet's syndrome (SS), or acute febrile neutrophilic dermatosis, characteristically presents with fever, dermal neutrophilic infiltrates, and neutrophilia. It typically manifests as tender erythematous plaques; however, various variants are documented, including bullous. Malignancy-associated Sweet's syndrome (MASS) can present as a paraneoplastic syndrome in those with established cancers or with undiagnosed malignancies. We present a 72-year-old male with a three-day history of a progressive bullous, erythematous papular rash starting on his right forearm and spreading to his extremities, trunk, palms, and soles. It was mildly pruritic but nontender. He had no recent febrile illnesses. On examination, the rash was violaceous with tense bullae overlying edematous targetoid papules coalescing into plaques. Histopathologic analysis of punch biopsies from his abdomen and thigh demonstrated dense inflammatory infiltrates of neutrophils, eosinophils, histiocytes, and lymphocytes, suggestive of neutrophilic dermatosis, or Sweet's syndrome. He was treated with prednisone 1 mg/kg with improvement in his cutaneous symptoms, and a malignancy workup was initiated. Blood work showed elevated free kappa, lambda light chains, lactate dehydrogenase (LDH), and C-reactive protein (CRP) levels. A positron emission tomography (PET) scan revealed lesions in the esophagus and kidney. He was referred to Heme/Onc, GI, and Urology. He was diagnosed with esophageal adenocarcinoma stage IIb and a renal mass. He has since completed neoadjuvant chemotherapy and radiation, is s/p robotic Ivor-Lewis esophagectomy with no evidence of residual carcinoma on pathology, and is undergoing surveillance with imaging every three months for his renal mass. This case highlights the importance of rapid identification of MASS and the impact dermatologists can make in getting these patients the potentially lifesaving care they need.
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Affiliation(s)
| | - Sarah Moore
- Dermatology, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Leslie Turner
- Dermatopathology, James A. Haley Veterans' Hospital, Tampa, USA
| | - Brooke Baldwin
- Dermatology, University of South Florida Morsani College of Medicine, Tampa, USA
- Dermatology, James A. Haley Veterans' Hospital, Tampa, USA
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Abd Elaziz D, El Hawary R, Meshaal S, Alkady R, Lotfy S, Eldash A, Erfan A, Chohayeb E, Saad M, Boutros J, Galal N, Elmarsafy A. Chronic Granulomatous Disease: a Cohort of 173 Patients-10-Years Single Center Experience from Egypt. J Clin Immunol 2023; 43:1799-1811. [PMID: 37433991 PMCID: PMC10661789 DOI: 10.1007/s10875-023-01541-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/19/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE Chronic granulomatous disease (CGD) is an inherited primary immunodeficiency disorder of phagocytes, characterized by recurrent fungal and bacterial infections. Our aim is to describe the different clinical presentations, non-infectious auto-inflammatory features, types and sites of infections, and to estimate the mortality among our large cohort. METHODS This is a retrospective study conducted at the Pediatric Department of Cairo University Children's Hospital in Egypt, including cases with a confirmed CGD diagnosis. RESULTS One hundred seventy-three confirmed CGD patients were included. AR-CGD was diagnosed in 132 patients (76.3%) including 83 patients (48%) with p47phox defect, 44 patients (25.4%) with p22phox defect, and 5 patients (2.9%) with p67phox defect. XL-CGD was diagnosed in 25 patients (14.4%). The most common recorded clinical manifestations were deep-seated abscesses and pneumonia. Gram-negative bacteria and Aspergillus were the most frequently isolated species. Regarding the outcome, 36 patients (20.8%) were lost from follow-up. Among patients with known outcome, 94/137 patients (68.6%) are living, while 43/137 patients (31.4%) died. CONCLUSION AR-CGD is predominant in Egypt; CGD must always be ruled out in any patient presenting with typical or atypical mycobacterial or BCG-disease.
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Affiliation(s)
- Dalia Abd Elaziz
- Pediatric Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Rabab El Hawary
- Clinical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Safa Meshaal
- Clinical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Radwa Alkady
- Pediatric Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sohilla Lotfy
- Pediatric Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Alia Eldash
- Clinical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Aya Erfan
- Clinical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Engy Chohayeb
- Pediatric Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mai Saad
- Pediatric Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Jeannette Boutros
- Pediatric Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nermeen Galal
- Pediatric Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Aisha Elmarsafy
- Pediatric Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Lu SY, Yang HF, Zeng QL, Chen P, Chen L, Gao J, Gu XK, Lan H, Luo M. Atypical Sweet syndrome: skin sinus tracts in an acutely febrile patient after lymphoma treatment: a case report. Front Immunol 2023; 14:1193808. [PMID: 37342351 PMCID: PMC10277476 DOI: 10.3389/fimmu.2023.1193808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 05/18/2023] [Indexed: 06/22/2023] Open
Abstract
Sweet syndrome (SS) is an uncommon inflammatory disease that involves painful skin, edematous, red papules, plaques, or nodules often accompanied by fever and leukocytosis. SS has three subtypes, including classical, malignant-tumor associated, and drug-induced SS (DISS). Patients with DISS have clear histories of recent drug exposure. The incidence of SS is high in hematological malignancy but rare in lymphomas. Glucocorticoid treatment is the recommended treatment for all subtypes of SS. This case study describes a male patient who had a history of sALCL(Systemic anaplastic large cell lymphoma) and was treated with multiple cycles of monoclonal-antibody (mAb) therapy. They also received the G-CSF injection at the site where skin lesions later developed. They met the diagnosis criteria for DISS, which was considered to be caused by the G-CSF injection. In addition, BV(Brentuximab vedotin) administration might predispose them to DISS. This case illustrates the first reported SS during the lymphoma treatment, with rare clinical presentations of local crater-like suppurative skin lesions. This case expands the available literature on SS and hematologic neoplasms and reminds clinicians to promptly recognize and diagnose SS to minimize patient morbidity and long-term sequelae.
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Affiliation(s)
- Shi-Ying Lu
- Department of Hematology, The Affiliated TCM Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hui-Fang Yang
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Qing-Li Zeng
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Peng Chen
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Li Chen
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Jing Gao
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Xue-Kui Gu
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Hai Lan
- Department of HematologyShunde Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Man Luo
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
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Zhao DW, Ni J, Sun XL. Histiocytoid giant cellulitis-like Sweet syndrome at the site of sternal aspiration: A case report and review of literature. World J Clin Cases 2022; 10:9768-9775. [PMID: 36186189 PMCID: PMC9516896 DOI: 10.12998/wjcc.v10.i27.9768] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/26/2022] [Accepted: 08/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Giant cellulitis-like Sweet syndrome (SS) is a rare subtype of SS, and reports of the combined histiocytoid type of pathology are scarce. Here, we report a case of SS with distinctive clinical presentations and which was difficult to distinguish from cellulitis. By sharing this case and a discussion of the related literature in detail, we aim to provide clinicians with new insights into the characteristics of histiocytoid giant cellulitis-like (HGC)-SS and the pathogenesis of SS.
CASE SUMMARY A 52-year-old male was admitted after experiencing progressive fatigue for 1 mo and tongue swelling with pain for 1 d. He was diagnosed with myelodysplastic syndrome (MDS) and angioneurotic edema of the tongue and floor of the mouth. However, 7 d after examination by sternal aspiration, a violaceous, tender, and swollen nodule developed at the site, with poorly demarcated erythema of the surrounding skin. Considering his profile of risk factors, the diagnosis of cellulitis was made and he was administered broad-spectrum antibiotics. When the lesion continued to worsen and he developed chills and fever, pathogenic and dermatopathological examination led to the diagnosis of HGC-SS. Treatment with prednisone led to the fever being relieved within 24 h and the skin lesion being resolved within 1 wk. The patient refused intensive treatment and was instead given thalidomide, erythropoietin, stanozolol, and supportive care. The prednisone was gradually tapered, with no signs of recurrence, but he died 2 mo later of severe pneumonia.
CONCLUSION HGC-SS demonstrates unique manifestation. SS and leukemia cutis share cytological origin. Myelofibrosis and SS are adverse prognostic factors for MDS.
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Affiliation(s)
- De-Wan Zhao
- Department of Hematology, The First Affiliated Hospital of Dalian Medical University, Dalian 116014, Liaoning Province, China
| | - Jing Ni
- Department of Dermatology, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
| | - Xiu-Li Sun
- Department of Hematology, The First Affiliated Hospital of Dalian Medical University, Dalian 116014, Liaoning Province, China
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Agrawal A, Arif SH, Kumarasan K, Janjua D. Sweet's Syndrome: An Update. Curr Pediatr Rev 2022; 18:265-273. [PMID: 35209834 DOI: 10.2174/1573396318666220223100208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/20/2021] [Accepted: 12/29/2021] [Indexed: 11/22/2022]
Abstract
Sweet's syndrome is a serious dermatological disorder characterized by a rapid onset of tender plaques or nodules, fever, joint pain, headache, and oral and genital lesions. According to the clinical features and underlying causes, Sweet's syndrome is divided into three categories, i.e., classical (or idiopathic), malignancy-associated Sweet's syndrome, and drug-induced Sweet's syndrome. It is multifactorial in etiology, and the exact cause is still undetermined. The diagnosis can be confirmed by the routine histopathologic evaluation of skin biopsy from the lesions. The first-line treatment options are topical and systemic steroids. Multiple databases, like Medline/PubMed, Scopus, and Google, were used to identify resources for this literature review. The relevant information was collected from various case reports, case series, reviews, meta-analyses, and large clinical trials reporting clinical description, etiology, diagnosis, and management of Sweet's syndrome. This narrative review aimed to discuss recent understandings related to Sweet's syndrome, both in terms of clinical presentation and management approach.
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Affiliation(s)
- Amit Agrawal
- Department of Pediatrics, Gandhi Medical College, Bhopal, MP, India
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Turner M, Chauhan K. Subcutaneous Sweet Syndrome Presenting as Cellulitis in a Pregnant Female. Cureus 2021; 13:e17999. [PMID: 34667675 PMCID: PMC8516325 DOI: 10.7759/cureus.17999] [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: 09/15/2021] [Indexed: 11/11/2022] Open
Abstract
We report a case of subcutaneous Sweet syndrome in a pregnant woman that was initially believed to be cellulitis. She was admitted after failure of symptom resolution following multiple oral antibiotics as an outpatient. Her rash continued to progress, and she became nauseous with a lack of appetite. Infectious disease, rheumatology, and dermatology were consulted. Skin biopsies were taken, and while awaiting results, due to continued disease progression despite broad-spectrum antibiotic coverage, IV steroids were started with rapid resolution. Eventual biopsy results showed a dense neutrophilic infiltrate in the subcutaneous fat in a lobular distribution without evidence of vasculitis, confirming a diagnosis of subcutaneous Sweet syndrome. This disease is exceedingly rare in pregnant patients, with few reported cases.
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Affiliation(s)
- Matt Turner
- Dermatology, Southern Illinois University School of Medicine, Springfield, USA
| | - Krati Chauhan
- Internal Medicine, Rheumatology, Southern Illinois University School of Medicine, Springfield, USA
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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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Keskinyan VS, Noyd DH, Underwood CM, Van Mater D. Sweet Syndrome in Pediatric Acute Myeloid Leukemia. J Pediatr Hematol Oncol 2021; 43:31-32. [PMID: 32925399 PMCID: PMC7736186 DOI: 10.1097/mph.0000000000001900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | - David H. Noyd
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Duke University Medical Center
| | | | - David Van Mater
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Duke University Medical Center
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Abstract
Haematological malignancies induce important alterations of the immune system, which account for the high frequency of autoimmune complications observed in patients. Cutaneous immune-mediated diseases associated with haematological malignancies encompass a heterogeneous group of dermatoses, including, among others, neutrophilic and eosinophilic dermatoses, autoantibody-mediated skin diseases, vasculitis and granulomatous dermatoses. Some of these diseases, such as paraneoplastic pemphigus, are associated with an increased risk of death; others, such as eosinophilic dermatoses of haematological malignancies, run a benign clinical course but portend a significant negative impairment on a patient’s quality of life. In rare cases, the skin eruption reflects immunological alterations associated with an unfavourable prognosis of the associated haematological disorder. Therapeutic management of immune-mediated skin diseases in patients with haematological malignancies is often challenging. Systemic corticosteroids and immunosuppressive drugs are considered frontline therapies but may considerably augment the risk of serious infections. Indeed, developing a specific targeted therapeutic approach is of crucial importance for this particularly fragile patient population. This review provides an up-to-date overview on the immune-mediated skin diseases most frequently encountered by patients with onco-haematological disorders, discussing new pathogenic advances and therapeutic options on the horizon.
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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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Gowda A, Christensen L, Polly S, Barlev D. Necrotizing neutrophilic dermatosis: A diagnostic challenge with a need for multi-disciplinary recognition, a case report. Ann Med Surg (Lond) 2020; 57:299-302. [PMID: 32874559 PMCID: PMC7452005 DOI: 10.1016/j.amsu.2020.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/18/2020] [Accepted: 07/18/2020] [Indexed: 11/12/2022] Open
Abstract
Introduction Necrotizing neutrophilic dermatoses can clinically resemble necrotizing fasciitis and therefore pose a diagnostic and therapeutic challenge. Given their similar presentations, misdiagnosis and inappropriate or delayed treatments are possible. Presentation of case We discuss the case of a woman with acute myeloid leukemia who presented with fevers, chills, cough, and a leg wound. She underwent amputation of her lower extremity after she was presumed to have necrotizing fasciitis; however, symptoms persisted. She was ultimately diagnosed with and treated for necrotizing Sweet's syndrome with notable clinical improvement. Discussion Both, necrotizing neutrophilic dermatoses and necrotizing fasciitis, grossly affect the skin and are associated with rapidly progressing systemic features including fevers, chills, leukocytosis, and elevated inflammatory markers. Recent literature in dermatology addresses these similarities and the appropriate approach to management; however, it is critical that medical and surgical subspecialties have an understanding of necrotizing neutrophilic dermatoses and their clinical presentations, diagnostic approaches, as well as therapeutic interventions. Familiarity with this entity can mitigate the risk of misdiagnosis, morbidity, and mortality. Conclusion With this report, we seek to review the features that are suggestive of and aid in the diagnosis of necrotizing neutrophilic dermatoses to help prevent significant and avoidable morbidity. Necrotizing neutrophilic dermatoses are a rare skin condition that can easily be misdiagnosed as necrotizing fasciitis. Providers from specialties like internal medicine, oncology, and surgery may encounter necrotizing neutrophilic dermatosis. Familiarity with the management of necrotizing neutrophilic dermatoses can reduce avoidable morbidity.
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Baloglu İH, Albayrak AT, Gunay KC, Yavuzsan AH, Kirecci SL. Regression of the Sweet's syndrome after Bacillus Calmette-Guérin therapy: A bladder cancer case report. Urol Case Rep 2020; 31:101202. [PMID: 32322522 PMCID: PMC7163327 DOI: 10.1016/j.eucr.2020.101202] [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: 03/23/2020] [Accepted: 04/08/2020] [Indexed: 11/03/2022] Open
Abstract
The Sweet's syndrome is a rare dermatosis which can be related to underlying malignancies. In this case we presented a case, who applied to our clinic with severe dermatosis and hematuria. We diagnosed high grade non-muscle invasive bladder tumor, which was treated with transurethral resection of bladder-tumor and six cycle of Bacillus Calmette-Guérin therapy. After the treatment the dermatosis was regressed almost completely. However, recurrent bladder tumor was detected at the first control cystoscopy.
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Affiliation(s)
- İbrahim Halil Baloglu
- University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital Urology Department Istanbul Turkey, Turkey
| | - Ahmet Tevfik Albayrak
- University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital Urology Department Istanbul Turkey, Turkey
| | - Kadir Cem Gunay
- University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital Urology Department Istanbul Turkey, Turkey
| | - Abdullah Hizir Yavuzsan
- University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital Urology Department Istanbul Turkey, Turkey
| | - Sinan Levent Kirecci
- University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital Urology Department Istanbul Turkey, Turkey
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Derpoorter C, Vandepoele K, Diez-Fraile A, Vandemeulebroecke K, De Wilde B, Speleman F, Van Roy N, Lammens T, Laureys G. Pinpointing a potential role for CLEC12B in cancer predisposition through familial exome sequencing. Pediatr Blood Cancer 2019; 66:e27513. [PMID: 30350915 DOI: 10.1002/pbc.27513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 09/24/2018] [Accepted: 09/24/2018] [Indexed: 11/06/2022]
Abstract
Predisposition to cancer is only partly understood, and thus, the contribution of still undiscovered cancer predisposing variants necessitates further research. In search of such variants, we performed exome sequencing on the germline DNA of a family with two children affected by ganglioneuroma and neuroblastoma. Applying stringent selection criteria, we identified a potential deleterious, missense mutation in CLEC12B, coding for a lectin C-type receptor that is predicted to regulate immune function. Although further screening in a larger population and functional characterization is needed, we propose CLEC12B as a candidate cancer predisposition gene.
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Affiliation(s)
- Charlotte Derpoorter
- Department of Pediatric Hematology-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Karl Vandepoele
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Araceli Diez-Fraile
- Department of Pediatric Hematology-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Katrien Vandemeulebroecke
- Department of Pediatric Hematology-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Bram De Wilde
- Department of Pediatric Hematology-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium.,Cancer Research Institute Ghent, Ghent, Belgium
| | - Frank Speleman
- Cancer Research Institute Ghent, Ghent, Belgium.,Center for Medical Genetics Ghent, Ghent University, Ghent, Belgium
| | - Nadine Van Roy
- Cancer Research Institute Ghent, Ghent, Belgium.,Center for Medical Genetics Ghent, Ghent University, Ghent, Belgium
| | - Tim Lammens
- Department of Pediatric Hematology-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium.,Cancer Research Institute Ghent, Ghent, Belgium
| | - Geneviève Laureys
- Department of Pediatric Hematology-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium.,Cancer Research Institute Ghent, Ghent, Belgium
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Abstract
Cutaneous infections are common in immunocompromised patients. Neutropenia predisposes patients to fungal, bacterial and viral infections. Antibacterial antifungal and antiviral prophylaxis have caused a significant reduction in some of these infections. There are two main types of cutaneous infections : primary cutaneous infections and cutaneous manifestations of a disseminated infection. In the latter, skin lesions may be the window to disseminated bloodstream infection and the first and only evidence of a disseminated life threatening infection. The diagnosis may be at your fingertips; therefore a thorough skin exam is the clue. However, it’s also important to know the characteristic lesions associated with different infections. It will help expedite diagnosis so appropriate treatment is initiated promptly in neutropenic patients, which can be lifesaving. In a retrospective study of 43 neutropenic febrile patients with cutaneous lesions, fungal infections were the most frequent, and nodular lesions on the lower extremities were the most prevalent (Naorungroj and Aiempanakit, J Am Acad Dermatol 74:AB166, 2016). Skin biopsy for pathological study and culture remains the gold standard and should be obtained early to confirm the suspected diagnosis. In these immunocompromised patients the inflammatory response is altered by either the primary disease or its treatment. Therefore, routine pathogens may present in an atypical fashion, with diminished or absent induration, erythema, or pustulation in response to bacterial resulting cutaneous infection without typical cellulitis (Urabe, Clin Infect Dis 39:S53–S55, 2004). Skin lesions are evaluated not only by morphology, but also in the context of the clinical setting and biopsy result. The skin biopsy is inexpensive, relatively noninvasive and without contraindication, and may avoid the need for more invasive procedures such an open lung biopsy (Grossman, et al., Cutaneous manifestations of infection in the immunocompromised host. Springer Science+Business Media, LLC, New York, 2012). In addition to antimicrobial therapy, surgery should not be postponed in the face of progressive skin and soft tissue infection in this population (Brzozowski and Ross, J Hand Surg Br 22:679–680, 1997).
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Affiliation(s)
| | - Jorge Lamarche
- James Haley VA Hospital, USF Morsani College of Medicine, Tampa, FL USA
| | - John N. Greene
- Moffitt Cancer Center and Research Institute, USF Morsani College of Medicine, Tampa, FL USA
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18
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[Sweet's syndrome induced by pegfilgrastim during a myelodysplastic syndrome AREB2: A case report]. Rev Med Interne 2018; 40:258-261. [PMID: 30551891 DOI: 10.1016/j.revmed.2018.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 11/11/2018] [Accepted: 11/15/2018] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Sweet's syndrome is an acute neutrophilic dermatosis characterized by abrupt onset of skin lesions accompanied by fever, arthralgia, leukocytosis and diffuse neutrophilic infiltration of the dermis, as well as an excellent response to corticosteroid therapy. CASE REPORT A 46-year-old patient with myelodysplastic syndrome was admitted for chemotherapy. On the eighth day of chemotherapy, he received a single dose of pegfilgrastim. Three days later, he developed pyrexia, conjunctivitis, arthralgia and erythematous and painful papulo-nodular lesions. Broad-spectrum empiric antibiotic therapy was started but the patient's condition deteriorated. Biology showed pancytopenia and inflammatory syndrome. Microbiological tests, autoimmune serologies and chest-computed tomography were negative. Cutaneous biopsy was compatible with Sweet's syndrome. A diagnosis of Sweet's syndrome induced by pegfilgrastim was made and intravenous corticosteroid therapy was started with a rapid favorable outcome. CONCLUSION Sweet's syndrome is a rare adverse effect of G-CSF.
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Cunha DG, Campos-do-Carmo G, Marujo JM, Verardino GC. Paraneoplastic Sweet's syndrome. An Bras Dermatol 2018; 93:576-578. [PMID: 30066769 PMCID: PMC6063096 DOI: 10.1590/abd1806-4841.20187353] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 11/05/2017] [Indexed: 12/04/2022] Open
Abstract
Sweet’s syndrome is a rare dermatosis with little-known pathogenesis, associated
with some clinical conditions such as infections, autoimmune diseases,
inflammatory bowel diseases, vaccination, medications and neoplasms. Hematologic
malignancies are the diseases most related to paraneoplastic Sweet’s syndrome,
but this clinical entity can also be found occasionally in some solid tumors,
including genitourinary tract tumors. We report a rare case of paraneoplastic
Sweet’s syndrome associated with the diagnosis of cervical cancer.
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Affiliation(s)
- Daniela Gomes Cunha
- Oncological Dermatology Service, Instituto Nacional do Câncer, Rio de Janeiro (RJ), Brazil
| | | | - Julia Macchione Marujo
- Oncological Dermatology Service, Instituto Nacional do Câncer, Rio de Janeiro (RJ), Brazil
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20
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Jang Y, Jang K, Kim N, Khwarg SI, Choung HK. Blindness in Sweet's Syndrome. KOREAN JOURNAL OF OPHTHALMOLOGY 2018; 31:570-571. [PMID: 29230979 PMCID: PMC5726993 DOI: 10.3341/kjo.2017.0084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Yeonji Jang
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Kyuhwan Jang
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Namju Kim
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Sang In Khwarg
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Ho Kyung Choung
- Department of Ophthalmology, Seoul Metropolitan Government-Seoul National University Hospital, Seoul, Korea
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Nofal A, Abdelmaksoud A, Amer H, Nofal E, Yosef A, Gharib K, Albalat W, Eldesouky F, Ebrahim HM, Abdelshafy AS, Fayed H. Sweet-Syndrom: Revision der diagnostischen Kriterien. J Dtsch Dermatol Ges 2017. [DOI: 10.1111/ddg.13350_g] [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]
Affiliation(s)
- Ahmad Nofal
- Dermatology Department; Faculty of Medicine; Zagazig University; Zagazig Ägypten
| | - Ayman Abdelmaksoud
- Mansoura Dermatology; Venereology and Leprology Hospital; Mansoura Ägypten
| | - Hala Amer
- Al-Haud Al-Marsoud Dermatology Hospital; Cairo Ägypten
| | - Eman Nofal
- Dermatology Department; Faculty of Medicine; Zagazig University; Zagazig Ägypten
| | - Ayman Yosef
- Dermatology Department; Faculty of Medicine; Zagazig University; Zagazig Ägypten
| | - Khaled Gharib
- Dermatology Department; Faculty of Medicine; Zagazig University; Zagazig Ägypten
| | - Waleed Albalat
- Dermatology Department; Faculty of Medicine; Zagazig University; Zagazig Ägypten
| | - Fatma Eldesouky
- Dermatology Department; Faculty of Medicine; Zagazig University; Zagazig Ägypten
| | - Howyda M. Ebrahim
- Dermatology Department; Faculty of Medicine; Zagazig University; Zagazig Ägypten
| | | | - Hala Fayed
- Al-Haud Al-Marsoud Dermatology Hospital; Cairo Ägypten
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Li AW, Yin ES, Stahl M, Kim TK, Panse G, Zeidan AM, Leventhal JS. The skin as a window to the blood: Cutaneous manifestations of myeloid malignancies. Blood Rev 2017; 31:370-388. [DOI: 10.1016/j.blre.2017.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/26/2017] [Accepted: 07/11/2017] [Indexed: 12/18/2022]
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Nofal A, Abdelmaksoud A, Amer H, Nofal E, Yosef A, Gharib K, Albalat W, Eldesouky F, Ebrahim HM, Abdelshafy AS, Fayed H. Sweet's syndrome: diagnostic criteria revisited. J Dtsch Dermatol Ges 2017; 15:1081-1088. [DOI: 10.1111/ddg.13350] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 06/01/2017] [Indexed: 01/06/2023]
Affiliation(s)
- Ahmad Nofal
- Dermatology Department; Faculty of Medicine; Zagazig University; Zagazig Egypt
| | - Ayman Abdelmaksoud
- Mansoura Dermatology; Venereology and Leprology Hospital; Mansoura Egypt
| | - Hala Amer
- Al-Haud Al-Marsoud Dermatology Hospital; Cairo Egypt
| | - Eman Nofal
- Dermatology Department; Faculty of Medicine; Zagazig University; Zagazig Egypt
| | - Ayman Yosef
- Dermatology Department; Faculty of Medicine; Zagazig University; Zagazig Egypt
| | - Khaled Gharib
- Dermatology Department; Faculty of Medicine; Zagazig University; Zagazig Egypt
| | - Waleed Albalat
- Dermatology Department; Faculty of Medicine; Zagazig University; Zagazig Egypt
| | - Fatma Eldesouky
- Dermatology Department; Faculty of Medicine; Zagazig University; Zagazig Egypt
| | - Howyda M. Ebrahim
- Dermatology Department; Faculty of Medicine; Zagazig University; Zagazig Egypt
| | | | - Hala Fayed
- Al-Haud Al-Marsoud Dermatology Hospital; Cairo Egypt
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25
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Sweet syndrome presenting as a febrile rash in a returning traveller. CAN J EMERG MED 2017; 20:476-478. [PMID: 28534449 DOI: 10.1017/cem.2017.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Sweet syndrome was discovered in 1964 and is now well described in the dermatology literature. Knowledge of this unique febrile and painful dermatosis is important for the emergency physician because the syndrome can be readily identified and is extremely responsive to oral steroid therapy. Early diagnosis can greatly improve patient satisfaction and avoid days of ineffective treatment. An accurate and timely diagnosis of Sweet syndrome is also important to guide investigation into a number of associated diseases.
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Özdoğu H, Yeral M, Boğa C. An Unusual Giant Leg Ulcer as a Rare Presentation of Sweet's Syndrome in a Patient with Hairy Cell Leukemia Successfully Managed by Splenectomy. Turk J Haematol 2017; 34:270-271. [PMID: 28270371 PMCID: PMC5544051 DOI: 10.4274/tjh.2016.0416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
| | - Mahmut Yeral
- Başkent University Faculty of Medicine, Department of Hematology, Ankara, Turkey
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Salman A, Berenjian A, Eser A, Kaymakçı FD, Cinel L, Kaygusuz Atagündüz I, Yücelten D, Ergun T. Bullous Sweet's Syndrome: Report of an Atypical Case Presenting with Ring-Like, Figurate Lesions. Turk J Haematol 2017; 34:118-119. [PMID: 26377250 PMCID: PMC5451680 DOI: 10.4274/tjh.2015.0202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Andaç Salman
- Marmara University Faculty of Medicine, Department of Dermatology, İstanbul, Turkey Phone : +90 216 657 06 06-3533 E-mail: ,
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Elevated 18F-FDG Uptake in Skeletal Muscles Rather Than Cutaneous Foci in a Patient With Sweet's Syndrome. Clin Nucl Med 2016; 41:938-940. [PMID: 27749403 DOI: 10.1097/rlu.0000000000001382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 64-year-old man was admitted to our hospital with a history of recurrent fever lasting 2 months. The initial physical examination for the patient showed normal cutaneous signs. An elevated uptake of tracer in skeletal muscles was observed by F-FDG PET/CT imaging. Three weeks later, a multitude of painful erythematous maculopapules appeared over his face, chest, and back. Pathological examination of a skin lesion showed papillary dermal edema with predominantly dense neutrophilic infiltrate in the dermis with no evidence of vasculitis, which was consistent with Sweet's syndrome.
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Villarreal-Villarreal C, Ocampo-Candiani J, Villarreal-Martínez A. Sweet Syndrome: A Review and Update. ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2016.05.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Amouri M, Masmoudi A, Ammar M, Boudaya S, Khabir A, Boudawara T, Turki H. Sweet's syndrome: a retrospective study of 90 cases from a tertiary care center. Int J Dermatol 2016; 55:1033-9. [PMID: 26967709 DOI: 10.1111/ijd.13232] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 10/19/2015] [Accepted: 11/04/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND Sweet's syndrome (SS) is a neutrophilic dermatosis characterized by the abrupt onset of cutaneous, systemic and histopathological alterations in response to different stimuli. OBJECTIVES The aim of this study was to assess the epidemioclinical, histological, and therapeutic features and outcomes of SS. METHODS A retrospective study of all patients diagnosed with SS over a 20-year period (1993-2012) was conducted. Data were analyzed using a level of significance of 5%. RESULTS Ninety patients (mean age: 46.5 years) fulfilled the inclusion criteria. The ratio of women to men was 5. Significant associations emerged between dermohypodermic nodes and location on the lower limbs (P = 0.042), and vesiculobullous lesions and location on the legs (P = 0.030), dorsum of the hand (P = 0.015), and forearms (P = 0.003), and paraneoplastic forms (P = 0.012). The upper extremities were involved in the majority of patients (83.3%). Correlations were found between edema of the superficial dermis and vesiculobullous lesions and between leukocytoclastic vasculitis and atypical targetoid lesions. Sweet's syndrome was associated with cytomegalovirus infection (n = 1), inflammatory bowel disease (n = 4), neoplasm (n = 6), and pregnancy (n = 3). First-line treatment consisted of colchicine. CONCLUSIONS To the best of the present authors' knowledge, this is the largest series of SS to be reported. Clinical presentations are similar to those described in the literature. Colchicine was efficient and facilitates the reduced use of corticosteroids. The association between SS and neoplasms should be considered in the context of vesiculobullous lesions.
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Affiliation(s)
- Meriem Amouri
- Department of Dermatology, Hedi Chaker Hospital, Sfax, Tunisia
| | | | - Morsi Ammar
- Department of Dermatology, Hedi Chaker Hospital, Sfax, Tunisia
| | - Sonia Boudaya
- Department of Dermatology, Hedi Chaker Hospital, Sfax, Tunisia
| | - Abdelmajid Khabir
- Department of Anatomopathology, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Tahia Boudawara
- Department of Anatomopathology, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Hamida Turki
- Department of Dermatology, Hedi Chaker Hospital, Sfax, Tunisia
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Sweet Syndrome: A Review and Update. ACTAS DERMO-SIFILIOGRAFICAS 2016; 107:369-78. [PMID: 26826881 DOI: 10.1016/j.ad.2015.12.001] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 12/14/2015] [Accepted: 12/15/2015] [Indexed: 12/20/2022] Open
Abstract
Sweet syndrome is the most representative entity of febrile neutrophilic dermatoses. It typically presents in patients with pirexya, neutrophilia, painful tender erytomatous papules, nodules and plaques often distributed asymmetrically. Frequent sites include the face, neck and upper extremities. Affected sites show a characteristical neutrophilic infiltrate in the upper dermis. Its etiology remains elucidated, but it seems that can be mediated by a hypersensitivity reaction in which cytokines, followed by infiltration of neutrophils, may be involved. Systemic corticosteroids are the first-line of treatment in most cases. We present a concise review of the pathogenesis, classification, diagnosis and treatment update of this entity.
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Gaopande VL, Joshi SS, Joshi AR. Acute promyelocytic leukemia-associated Sweet's syndrome mimicking an axillary abscess: A case report with review of literature. Diagn Cytopathol 2015; 43:1007-10. [PMID: 26390119 DOI: 10.1002/dc.23367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 06/26/2015] [Accepted: 09/02/2015] [Indexed: 01/09/2023]
Abstract
A subcutaneous painful left axillary nodule was clinically diagnosed as abscess. Fine-needle aspiration biopsy (FNAB) revealed smears full of mature neutrophils. Background was free of fibrinous necrotic material and degenerating and necrotic neutrophils, which is characteristic of abscess. No organisms were detectable on special staining, and culture was sterile. A cytological differential diagnosis of abscess or Sweet's syndrome (SS) was offered, and the latter was confirmed. SS, also known as acute febrile neutrophilic dermatosis, shows diffuse dermal neutrophilic infiltrate without vasculitis on biopsy. Our case is probably the first where SS was diagnosed on FNAB. SS is a differential diagnosis for painful skin nodules. FNAB smears of painful skin nodules that yield abundant neutrophils should be carefully evaluated for necrosis, fibrin and degenerated neutrophils. The absence of these in an appropriate clinical setting points towards a neutrophilic dermatosis like SS.
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Affiliation(s)
- Vandana L Gaopande
- Department of Pathology, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| | - Sourabh S Joshi
- Department of Pathology, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| | - Avinash R Joshi
- Department of Pathology, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
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Isaac RE, Sinson D, Jones S. Sweet syndrome. Br J Oral Maxillofac Surg 2015; 53:894-5. [PMID: 26116292 DOI: 10.1016/j.bjoms.2015.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 06/02/2015] [Indexed: 10/23/2022]
Affiliation(s)
| | - Dom Sinson
- Oral and Maxillofacial Surgery Department, Royal Gwent Hospital, Newport
| | - Simon Jones
- Consultant Oral & Maxillofacial Surgeon, Royal Gwent Hospital, Newport
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Herbert-Cohen D, Jour G, Saul T. Sweet's Syndrome. J Emerg Med 2015; 49:e95-7. [PMID: 26026574 DOI: 10.1016/j.jemermed.2015.02.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 02/26/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Daniel Herbert-Cohen
- Department of Emergency Medicine, St. Luke's-Roosevelt Hospital Center, New York, New York
| | - George Jour
- Department of Emergency Medicine, St. Luke's-Roosevelt Hospital Center, New York, New York
| | - Turandot Saul
- Department of Emergency Medicine, St. Luke's-Roosevelt Hospital Center, New York, New York
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35
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Jain K, Mudaliar S, Swami A. Sweet's Syndrome with Myelodysplasia. Indian J Pediatr 2015; 82:571-2. [PMID: 25650233 DOI: 10.1007/s12098-015-1691-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 01/07/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Kashmira Jain
- Department of Pediatric Hematology and Oncology, B. J. Wadia Hospital for Children, Mumbai, India
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Li B, Ma Z, Xu X, Yin J, Wang X, Ren J, Wang S, Yang J, Ma T, Zhang Q, Yu J, Yan B. Multi-organ involvement of Sweet's syndrome: a case report and literature review. Intern Med 2015; 54:339-43. [PMID: 25748744 DOI: 10.2169/internalmedicine.54.2755] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The hallmark of Sweet's syndrome (SS) is the infiltration of mature neutrophils in the upper dermis. We herein report a case of SS with multi-organ involvement. A 32-year-old man presented with fever, anemia and dyspnea. He was given antibiotics, without any improvements. Later, a number of erythematous lesions appeared, accompanied by deteriorating respiratory and cardiovascular functions. A diagnosis of SS was confirmed on a skin biopsy, and the patient was given corticosteroids, the dose of which was reduced after one month. The organ function subsequently deteriorated, and he ultimately died of multi-organ failure. Early recognition of SS with multi-organ involvement is important in patients with SS.
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Affiliation(s)
- Bo Li
- Department of Respiratory Medicine, Second Clinical Hospital, Jilin University; Department of Occupational Disease Prevention, Jilin Provincial Occupational Disease Prevention and Treatment, China
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Abstract
Neutrophilic dermatoses constitute a heterogeneous group of dermatologic diseases, which are unified by the predominance of neutrophils within the inflammatory infiltrate on histopathology. The aims of this review were to provide an update on the clinical and histologic presentation of the main neutrophilic dermatoses and to develop a guide for clinical practice. A structured literature search of PubMed, Medline, and Embase was performed, using the key words "neutrophilic disorders", "cutaneous small vessel vasculitis", "Sweet's syndrome", "bowel associated dermatosis arthritis syndrome", "Behcet's", "palisaded neutrophilic and granulomatous dermatosis", "rheumatoid neutrophilic dermatitis", and "pyoderma gangrenosum". Related articles were screened for key terms and were included if appropriate. This group contains a wide spectrum of unique disorders, each with its own histologic and clinical subtleties, making specific diagnosis of a given entity within the group diagnostically challenging. The fact that overlapping forms of neutrophilic dermatoses, which share features of multiple neutrophilic dermatoses, are not uncommon makes the diagnoses more challenging.
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Alkayem M, Cheng W. A case report of hairy cell leukemia presenting concomitantly with sweet syndrome. Case Rep Med 2014; 2014:823286. [PMID: 24715920 PMCID: PMC3970440 DOI: 10.1155/2014/823286] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 12/08/2013] [Accepted: 01/05/2014] [Indexed: 12/26/2022] Open
Abstract
Hairy cell leukemia and Sweet syndrome are both uncommon hematological diagnoses. We present a patient who was admitted with fevers, pancytopenia, pneumonia, and rash. Diagnostic bone marrow biopsy demonstrates Hairy cell Leukemia and skin biopsy demonstrates neutrophils infiltration consistent with Sweet syndrome. The patient was treated with purine analogs with resolution of the cytopenias, infection, and rash.
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Affiliation(s)
- Mohammad Alkayem
- Internal Medicine Department, Lincoln Medical and Mental Health Center, 234 E 149th Street, Bronx, NY 10451, USA
| | - Waina Cheng
- Hematology and Oncology Department, Lincoln Medical and Mental Health Center, 234 E 149th Street, Bronx, NY 10451, USA
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Zobniw CM, Saad SA, Kostoff D, Barthel BG. Bortezomib-Induced Sweet's Syndrome Confirmed by Rechallenge. Pharmacotherapy 2013; 34:e18-21. [DOI: 10.1002/phar.1383] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Chrystia M. Zobniw
- Department of Pharmacy Services; Roswell Park Cancer Institute; Buffalo New York
| | - Samira A. Saad
- Department of Pharmacy Services; C.S. Mott Children's Hospital; University of Michigan Health System; Ann Arbor Michigan
| | - Diana Kostoff
- Department of Pharmacy Services; Henry Ford Health System; Detroit Michigan
| | - Bernd G. Barthel
- Department of Hematology and Oncology; Henry Ford Health System; Detroit Michigan
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