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Delaleu J, Bouaziz JD. Overview of Neutrophilic Biology, Pathophysiology, and Classification of Neutrophilic Dermatoses. Dermatol Clin 2024; 42:147-156. [PMID: 38423677 DOI: 10.1016/j.det.2023.08.002] [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: 03/02/2024]
Abstract
Neutrophilic dermatoses are a group of inflammatory skin conditions characterized by a neutrophilic infiltrate on histopathology with no evidence of infection. These conditions present with a wide range of clinical manifestations, including pustules, bullae, abscesses, papules, nodules, plaques, and ulcers. The classification of neutrophilic dermatoses is based on the localization of neutrophils in the skin. The pathogenic mechanisms of neutrophilic dermatoses involve autoinflammation, neutrophilic dysfunction, clonal somatic mutation and differentiation of the myeloid precursors as encountered in myeloid neoplasm.
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Affiliation(s)
- Jérémie Delaleu
- Dermatology Department, Saint Louis Hospital, APHP Nord Université Paris Cité and INSERM u976 "Human Immunology, Pathophysiology and Immunotherapy", Paris, France
| | - Jean-David Bouaziz
- Dermatology Department, Saint Louis Hospital, APHP Nord Université Paris Cité and INSERM u976 "Human Immunology, Pathophysiology and Immunotherapy", Paris, France.
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2
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Borges T, Silva S. Panniculitis: A Cardinal Sign of Autoinflammation. Curr Rheumatol Rev 2024; 20:350-360. [PMID: 37921131 DOI: 10.2174/0115733971254702231020060633] [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: 03/26/2023] [Revised: 08/19/2023] [Accepted: 09/01/2023] [Indexed: 11/04/2023]
Abstract
Panniculitis was first described in the nineteenth century and is characterized by inflammation of the subcutaneous fat. It may be categorized in septal or lobular subtypes, but other histopathological features (e.g., presence of vasculitis, nature of inflammatory infiltrates, characteristics of fat necrosis) are also important for diagnostic purposes. Clinically, panniculitis is characterized by the presence of subcutaneous nodules, and both ulcerative and nonulcerative clinical subtypes have been proposed. In this review, we aimed to describe the occurrence of panniculitis in autoinflammatory disorders (AIDs) and related diseases. Among monogenic AIDs, panniculitis is common in IFN-mediated disorders. Panniculitis is a distinctive feature in proteasome-associated autoinflammatory syndromes (PRAAS), including chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature (CANDLE) syndrome and Nakajo-Nishimura syndrome. On the other hand, erythema nodosum corresponds to the most common clinical form of panniculitis and is common in polygenic AIDs, such as Behçet's syndrome, inflammatory bowel disease, and sarcoidosis. Cytophagic histiocytic panniculitis, lipoatrophic panniculitis of children, and otulipenia are rare disorders that may also present with inflammation of the subcutaneous fat. Therefore, panniculitis can identify a specific subgroup of patients with AIDs and may potentially be regarded as a cardinal sign of autoinflammation.
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Affiliation(s)
- Tiago Borges
- Trofa Saúde Gaia, Rua Fernão de Magalhães nº 2 Fr E, 4404-501 Vila Nova de Gaia, Portugal
| | - Sérgio Silva
- Trofa Saúde Gaia, Rua Fernão de Magalhães nº 2 Fr E, 4404-501 Vila Nova de Gaia, Portugal
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Gil-Lianes J, Luque-Luna M, Alamon-Reig F, Bosch-Amate X, Serra-Garcia L, Mascaró JM. Sweet Syndrome: Clinical Presentation, Malignancy Association, Autoinflammatory Disorders and Treatment Response in a Cohort of 93 Patients with Long-term Follow-up. Acta Derm Venereol 2023; 103:adv18284. [PMID: 38112209 PMCID: PMC10753595 DOI: 10.2340/actadv.v103.18284] [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: 07/21/2023] [Accepted: 10/03/2023] [Indexed: 12/21/2023] Open
Abstract
Sweet syndrome is a neutrophilic dermatosis associated with multiple disorders. This retrospective case-series study of patients with Sweet syndrome in a tertiary hospital in Spain from 2001 to 2021, explores clinicopathological characteristics of Sweet syndrome and variables associated with malignancy, presence of autoinflammatory disorders and differences between histological subtypes. A total of 93 patients were identified: 30% idiopathic, 34% malignancy-associated, 29% reactive to infections or drug-associated, and 6% with an autoimmune/inflammatory condition. Acute myeloid leukaemia was the most common malignancy (16/93) followed by myelodysplastic syndrome (7/93). Patients with acute myeloid leukaemia presented isolated flares, marked cytopaenia and rapid response to treatment, whereas myelodysplastic syndrome followed a chronic-recurrent course. The most frequent associated medications and inflammatory disorders were filgrastim and hydroxyurea (n = 2); and inflammatory bowel disease (n = 4). In addition, 3 patients were diagnosed with VEXAS syndrome. Male sex (p = 0.006), fever (p = 0.034), increased erythrocyte sedimentation rate (p < 0.001), anaemia (p < 0.001), and thrombocytopaenia (p < 0.001) were associated with malignancy. Histologically, patients were classified as classic (60%), histiocytoid (22.5%) or subcutaneous (15%), with pain (p = 0.011) and nodules (p < 0.001) being associated with subcutaneous-Sweet syndrome. Sweet syndrome in the context of cytopaenia should alert the presence of malignancy. An acquired autoinflammatory condition should be explored in relapsing Sweet syndrome with myelodysplastic syndrome. A minimum follow-up of 6 months is recommended.
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Affiliation(s)
- Javier Gil-Lianes
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain
| | - Mar Luque-Luna
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain
| | - Francesc Alamon-Reig
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain
| | - Xavier Bosch-Amate
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain
| | - Laura Serra-Garcia
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain
| | - José M Mascaró
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain.
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Prieto-Torres L, Requena L, Rodríguez-Pinilla SM. Clinical, Histopathological and Molecular Spectrum of Cutaneous Lesions in Myelodysplastic Syndrome and Myeloproliferative Neoplasms (MDS/MPN): An Integrative Review. Cancers (Basel) 2023; 15:5888. [PMID: 38136431 PMCID: PMC10742063 DOI: 10.3390/cancers15245888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/07/2023] [Accepted: 12/16/2023] [Indexed: 12/24/2023] Open
Abstract
Myeloid neoplasms and acute leukemias include different entities that have been recently re-classified taking into account molecular and clinicopathological features. The myelodysplastic syndrome/myeloproliferative neoplasm (MDS/MPN) category comprises a heterogeneous group of hybrid neoplastic myeloid diseases characterized by the co-occurrence of clinical and pathological features of both myelodysplastic and myeloproliferative neoplasms. The most frequent entity in this category is chronic myelomonocytic leukemia (CMML) which is, after acute myeloid leukemia (AML), the main myeloid disorder prone to develop cutaneous manifestations. Skin lesions associated with myelodysplastic and myeloproliferative neoplasms include a broad clinical, histopathological and molecular spectrum of lesions, poorly understood and without a clear-cut classification in the current medical literature. The aim of this review is to describe and classify the main clinical, histopathological and molecular patterns of cutaneous lesions in the setting of MDS/MPN in order to improve the diagnostic skills of the dermatologists, hematologists and pathologists who deal with these patients.
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Affiliation(s)
- Lucía Prieto-Torres
- Department of Dermatology, Hospital Clínico Universitario Lozano Blesa, Universidad de Zaragoza, 50009 Zaragoza, Spain
| | - Luis Requena
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, 28040 Madrid, Spain;
| | - Socorro Maria Rodríguez-Pinilla
- Department of Pathology, Fundación Jiménez Díaz, Universidad Autónoma, 50019 Zaragoza, Spain;
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28040 Madrid, Spain
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Cohen AJ, Gleason LK, Bhatti SA, Nikbakht N. Neutrophilic panniculitis associated with myelodysplastic syndrome/myeloproliferative neoplasm: a case report and literature review. INTERNATIONAL JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2023; 6:168-171. [PMID: 37811487 PMCID: PMC10552795 DOI: 10.1097/jd9.0000000000000286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Introduction Neutrophilic panniculitis (NP) is a rare subtype of neutrophilic dermatosis, a group of neutrophil-rich inflammatory skin disorders that can present in association with myeloid neoplasms. NP is defined by the presence of a neutrophilic infiltrate in the fat lobules of the subcutis in the absence of either infection or vasculitis. We herein describe a 65-year-old woman with a recent diagnosis of myelodysplastic syndrome/myeloproliferative neoplasm overlap syndrome (MDS/MPN) who abruptly developed painful, pruritic nodules consistent with NP. Case presentation A 65-year-old woman with MDS/MPN presented for evaluation of painful and pruritic nodules on her upper and lower extremities. A biopsy revealed a lobular neutrophilic infiltrate in the subcutis without evidence of microorganisms or vasculitis. The patient was diagnosed with NP and treated with oral prednisone. Within 1 month of treatment, she reported complete resolution of the nodules. Discussion Similar to other neutrophilic dermatoses, NP may arise in association with hematologic malignancies of myeloid origin, such as MDS/MPN. A literature review revealed that most cases of NP associated with MDS occur after the onset of MDS and respond to systemic corticosteroids, not antibiotics. Infection should be ruled out before initiating treatment with systemic steroids. Conclusion Although the mechanism is still unknown, it is important for clinicians to be aware that NP is associated with MDS; thus, hematological malignancies should be investigated upon diagnosis of NP. Once diagnosed, NP is easily treated and has an excellent response to systemic corticosteroids.
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Affiliation(s)
- Alexa J. Cohen
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Laura K. Gleason
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Safiyyah A. Bhatti
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
- Department of Hematology & Oncology, Thomas Jefferson University, Philadelphia, PA
| | - Neda Nikbakht
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
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Fenner B, Cavazos A, Mui U, Tarbox M. Drug-induced neutrophilic lobular panniculitis secondary to BRAF and MEK inhibitor used for treatment of low-grade glioma and its management. Proc AMIA Symp 2023; 36:521-523. [PMID: 37334075 PMCID: PMC10269401 DOI: 10.1080/08998280.2023.2205811] [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: 02/01/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 06/20/2023] Open
Abstract
An 8-year-old boy presented with his mother for evaluation of an erythematous rash 3 weeks after the start of dual BRAF-MEK inhibition with dabrafenib and trametinib for treatment of progression of low-grade glioma. Panniculitis has been reported as a rare adverse cutaneous event induced by BRAF inhibitors, MEK inhibitors, and the combined dual BRAF-MEK therapy. Based on the patient's history, clinical presentation, and histopathological findings, a diagnosis of drug-induced neutrophilic panniculitis was made. This case describes neutrophilic panniculitis as a potential cutaneous manifestation of dual BRAF-MEK inhibitor therapy and describes the management of such side effects. Neutrophilic panniculitis is a relatively rare manifestation, characterized by neutrophilic inflammation in the subcutaneous tissue. Additionally, this case serves as a reminder to consider the cutaneous side effects of such therapies, given that MEK and BRAF inhibitors are increasingly used to treat primary brain tumors in the pediatric population. Routine inspection and early management may improve patients' quality of life and enable continuation of anticancer therapy.
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Affiliation(s)
- Blayne Fenner
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Annia Cavazos
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Uyen Mui
- Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Michelle Tarbox
- Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock, Texas
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Thomas JL, Tee MW, Harp J, Magro C. Azathioprine hypersensitivity syndrome manifesting as subcutaneous Sweet syndrome and acute pancreatitis. J Cutan Pathol 2023; 50:127-130. [PMID: 35983669 DOI: 10.1111/cup.14315] [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: 01/25/2022] [Revised: 08/03/2022] [Accepted: 08/15/2022] [Indexed: 01/24/2023]
Abstract
Azathioprine (AZA) is a commonly used immunosuppressive therapy that has been implicated in a number of cutaneous and systemic inflammatory reactions. Initiation of AZA has been associated with a hypersensitivity syndrome manifesting as acute pancreatitis and Sweet syndrome. Subcutaneous Sweet syndrome is a rare variant of Sweet syndrome where the dominant localization of inflammation is within the subcutaneous fat; it is commonly associated with underlying myeloproliferative disease. However, it has not been reported in the literature as a cutaneous manifestation of AZA hypersensitivity syndrome. We present a unique case of acute pancreatitis and biopsy-proven subcutaneous Sweet syndrome following the initiation of AZA with resolution upon discontinuation.
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Affiliation(s)
| | - Michael W Tee
- Department of Dermatology, Weill Cornell Medicine, New York, New York, USA
| | - Joanna Harp
- Department of Dermatology, Weill Cornell Medicine, New York, New York, USA
| | - Cynthia Magro
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
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Muacevic A, Adler JR, Eusébio SP, Prayce R, Pires P. From the Deep: Overlap of Neutrophilic Dermatoses Disorders Associated With Acute Myeloid Leukemia. Cureus 2023; 15:e33456. [PMID: 36751214 PMCID: PMC9897686 DOI: 10.7759/cureus.33456] [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: 01/06/2023] [Indexed: 01/09/2023] Open
Abstract
We report the case of a man in his 50s with refractory acute myelomonocytic leukaemia (AML) who presented with neck swelling, fever, and elevated levels of C-reactive protein (CPR) after venous punctures. An infected haematoma was presumed, but the patient showed no signs of improvement under broad-range antibiotics, and microbiological results were negative. The subsequent development of a rapidly evolving erythematous-violaceous plaque around a site that had previously punctured on the extensor surface of the right arm prompted us to reconsider the clinical setting as a whole and consider the hypothesis of deep neutrophilic dermatosis (ND) associated with haematologic malignancy. A biopsy of the arm lesion showed an aseptic neutrophilic infiltrate, confirming this diagnosis. The patient was initially treated with high-dose intravenous corticosteroids, resulting in a dramatic improvement of the skin lesions.
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Delaleu J, Lepelletier C, Calugareanu A, De Masson A, Charvet E, Petit A, Giurgea I, Amselem S, Karabina S, Jachiet M, Mahevas T, Ram-Wolff C, Vignon-Pennamen MD, Bagot M, Battistella M, Bouaziz JD. Neutrophilic dermatoses. Rev Med Interne 2022; 43:727-738. [PMID: 35870984 DOI: 10.1016/j.revmed.2022.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 04/27/2022] [Accepted: 06/12/2022] [Indexed: 10/17/2022]
Abstract
Neutrophilic dermatoses (ND) are a group of inflammatory skin conditions characterized by a neutrophilic infiltrate on histopathology with no evidence of infection. ND are classified based upon the localization of neutrophils within the skin and clinical features. Recent findings suggest that ND are due to two main mechanisms: i) a polyclonal hereditary activation of the innate immune system (polygenic or monogenic); or ii) a clonal somatic activation of myeloid cells such as encountered in myelodysplastic syndrome or VEXAS syndrome. ND belong to internal medicine as a great number of patients with ND suffer from an underlying condition (such as hematological malignancy, inflammatory bowel disease, auto-immune and auto-inflammatory diseases). ND are diagnoses of exclusion and physicians should always consider differential diagnoses, particularly skin infections. Here, we review the pathophysiology and classification of the main ND (i.e., subcorneal pustular dermatosis (Sneddon-Wilkinson Disease) and Intercellular IgA dermatoses, aseptic pustulosis of the folds, Sweet syndrome, neutrophilic eccrine hidradenitis, pyoderma gangrenosum, erythema elevatum diutinum, neutrophilic urticarial dermatosis and neutrophilic panniculitis), their clinical and histopathological features, and we highlight the investigations that are useful to identify ND-associated diseases and to exclude the differential diagnoses.
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Affiliation(s)
- J Delaleu
- Service de dermatologie, hôpital Saint-Louis, AP-HP, Paris, France; Inserm u976 "Human Immunology, Pathophysiology and Immunotherapy", université Paris Cité, Paris, France; Inserm u933, "Childhood genetic disorders", service de génétique, Sorbonne université, hôpital Armand-Trousseau, AP-HP, Paris, France
| | - C Lepelletier
- Service de dermatologie, hôpital Saint-Louis, AP-HP, Paris, France; Inserm u976 "Human Immunology, Pathophysiology and Immunotherapy", université Paris Cité, Paris, France
| | - A Calugareanu
- Service de dermatologie, Severe Cutaneous Adverse Reaction (SCAR) Regional Center, HCL, CHU de Lyon Centre, Lyon, France
| | - A De Masson
- Service de dermatologie, hôpital Saint-Louis, AP-HP, Paris, France; Inserm u976 "Human Immunology, Pathophysiology and Immunotherapy", université Paris Cité, Paris, France
| | - E Charvet
- Service de dermatologie, hôpital Saint-Louis, AP-HP, Paris, France; Inserm u976 "Human Immunology, Pathophysiology and Immunotherapy", université Paris Cité, Paris, France
| | - A Petit
- Service de dermatologie, hôpital Saint-Louis, AP-HP, Paris, France; Inserm u976 "Human Immunology, Pathophysiology and Immunotherapy", université Paris Cité, Paris, France
| | - I Giurgea
- Inserm u933, "Childhood genetic disorders", service de génétique, Sorbonne université, hôpital Armand-Trousseau, AP-HP, Paris, France
| | - S Amselem
- Inserm u933, "Childhood genetic disorders", service de génétique, Sorbonne université, hôpital Armand-Trousseau, AP-HP, Paris, France
| | - S Karabina
- Inserm u933, "Childhood genetic disorders", service de génétique, Sorbonne université, hôpital Armand-Trousseau, AP-HP, Paris, France
| | - M Jachiet
- Service de dermatologie, hôpital Saint-Louis, AP-HP, Paris, France; Inserm u976 "Human Immunology, Pathophysiology and Immunotherapy", université Paris Cité, Paris, France
| | - T Mahevas
- Service de dermatologie, hôpital Saint-Louis, AP-HP, Paris, France; Inserm u976 "Human Immunology, Pathophysiology and Immunotherapy", université Paris Cité, Paris, France
| | - C Ram-Wolff
- Service de dermatologie, hôpital Saint-Louis, AP-HP, Paris, France; Inserm u976 "Human Immunology, Pathophysiology and Immunotherapy", université Paris Cité, Paris, France
| | - M-D Vignon-Pennamen
- Inserm u976 "Human Immunology, Pathophysiology and Immunotherapy", université Paris Cité, Paris, France; Service d'anatomie pathologique, hôpital Saint-Louis, AP-HP, Paris, France
| | - M Bagot
- Service de dermatologie, hôpital Saint-Louis, AP-HP, Paris, France; Inserm u976 "Human Immunology, Pathophysiology and Immunotherapy", université Paris Cité, Paris, France
| | - M Battistella
- Inserm u976 "Human Immunology, Pathophysiology and Immunotherapy", université Paris Cité, Paris, France; Service d'anatomie pathologique, hôpital Saint-Louis, AP-HP, Paris, France
| | - J-D Bouaziz
- Service de dermatologie, hôpital Saint-Louis, AP-HP, Paris, France; Inserm u976 "Human Immunology, Pathophysiology and Immunotherapy", université Paris Cité, Paris, France.
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Saghir S, Meskini T, Ettair S, Erreimi N, Mouane N. [Weber-Christian's disease: a preleukemic disorder?]. Pan Afr Med J 2019; 32:127. [PMID: 31223415 PMCID: PMC6561002 DOI: 10.11604/pamj.2019.32.127.16106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 07/19/2018] [Indexed: 11/13/2022] Open
Abstract
La maladie de Weber-Christian ou panniculite idiopathique est une affection rare, caractérisée par une inflammation du tissu adipeux sous-cutané; il s'agit d'une entité pathologique non spécifique qui reste toujours un sujet de débat et dont l'évolution est imprévisible. Nous rapportons dans cet article le cas d'un nourrisson de sexe féminin de 9 mois, admise dans un tableau de sepsis précédé d'une symptomatologie respiratoire et suivi de l'apparition de nodosités sous cutanées érythémateuses, de petite taille, dures, sensibles, asymétriques et situées au niveau des bras et des membres inférieurs, la biopsie cutanée a montré une hypodermite lobulaire avec infiltration des polynucléaires neutrophiles. La maladie de Weber-Christian a été retenue après avoir éliminé les autres diagnostics différentiels. Notre patiente a été traitée par la prednisone avec une bonne évolution initiale. Durant le suivi et au cours de la dégression, le diagnostic d'une leucémie aigue lymphoblastique type B a été posé. Cette évolution atypique à notre connaissance n'a jamais été décrite dans la littérature. Nous allons discuter à travers ce cas les différentes situations similaires où un autre diagnostic a été fait après avoir pris en charge les malades comme ayant une panniculite lobulaire idiopathique, en concluant de la nécessité d'une enquête étiologique exhaustive et d'une surveillance prolongée afin de rechercher une éventuelle pathologie associée.
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Affiliation(s)
- Salahiddine Saghir
- Département d'Hépato-gastroentérologie et de Nutrition-P III, Université Mohammed V, Rabat, Maroc
| | - Toufik Meskini
- Département d'Hépato-gastroentérologie et de Nutrition-P III, Université Mohammed V, Rabat, Maroc
| | - Said Ettair
- Département d'Hépato-gastroentérologie et de Nutrition-P III, Université Mohammed V, Rabat, Maroc
| | - Naima Erreimi
- Département d'Hépato-gastroentérologie et de Nutrition-P III, Université Mohammed V, Rabat, Maroc
| | - Nezha Mouane
- Département d'Hépato-gastroentérologie et de Nutrition-P III, Université Mohammed V, Rabat, Maroc
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Marzano AV, Borghi A, Wallach D, Cugno M. A Comprehensive Review of Neutrophilic Diseases. Clin Rev Allergy Immunol 2017; 54:114-130. [DOI: 10.1007/s12016-017-8621-8] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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12
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Vemurafenib-Induced Neutrophilic Panniculitis: A New Case and Review of the Literature. Am J Dermatopathol 2017; 38:e93-6. [PMID: 26959695 DOI: 10.1097/dad.0000000000000528] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Vemurafenib has proved to be useful in the treatment of patients with unresectable or metastatic melanoma harboring the BRAF-V600E mutation, with better rates of overall and progression-free survival than previous treatments. Adverse cutaneous effects, such as alopecia, pruritus, photosensitivity reactions, verrucous keratosis, keratoacanthomas, or squamous cell carcinomas, have been described. Thirty cases of vemurafenib-associated panniculitis are available in the literature with variable clinical relevance. Only 9 of them exhibited definitive evidence of neutrophilic panniculitis. They all consist of multiple lesions, usually located in the lower limbs. Histopathologically, they have been described as predominantly neutrophilic, lymphocytic, or mixed, more commonly with lobular location. We report an additional case of neutrophilic panniculitis in a 45-year-old woman treated with vemurafenib for metastatic melanoma, presenting as a single lesion on his right leg. The lesion resolved spontaneously and did not need treatment reduction. The presentation of this condition with a single lesion is particularly challenging. Recognition of this association is important given the increasing use of vemurafenib and the potential implications of treatment withdrawal.
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Ricardo-Gonzalez RR, Lin JR, Mathes EF, McCalmont TH, Pincus LB. Neutrophil-rich subcutaneous fat necrosis of the newborn: A potential mimic of infection. J Am Acad Dermatol 2016; 75:177-185.e17. [PMID: 27157147 DOI: 10.1016/j.jaad.2016.02.1151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 01/14/2016] [Accepted: 02/03/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND The inflammatory infiltrate seen in biopsy specimens obtained from patients with subcutaneous fat necrosis of the newborn (SCFN) has classically been described as consisting mostly of histiocytes. However, we encountered patients with SCFN whose biopsy specimens revealed mostly neutrophils, prompting infection to be an initial consideration. OBJECTIVES We sought to describe cases of SCFN in which neutrophils formed the majority of the infiltrate at our institution and in the literature. METHODS We performed a retrospective analysis of patients with SCFN reported at our institution and a literature review of SCFN. RESULTS Thirteen cases of SCFN were identified at our institution. In 2 of 13 cases, neutrophils composed >75% of the inflammatory infiltrate, and both lesions were 1 day old. From the literature review, neutrophils were mentioned as a component of the infiltrate in 10 of 124 cases, but in none were neutrophils described as forming the majority of the infiltrate. LIMITATIONS This study is limited by its retrospective nature and small sample size. CONCLUSIONS Neutrophils can comprise most of the inflammatory cells in patients with SCFN, especially early in the course of the disease. This variant of SCFN can be easily mistaken for infection.
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Affiliation(s)
| | - James R Lin
- Department of Medicine, Kaiser Permanente Medical Center, Santa Clara, California
| | - Erin F Mathes
- Department of Dermatology, University of California, San Francisco, California
| | - Timothy H McCalmont
- Department of Dermatology, University of California, San Francisco, California; Department of Pathology, University of California, San Francisco, California
| | - Laura B Pincus
- Department of Dermatology, University of California, San Francisco, California; Department of Pathology, University of California, San Francisco, California.
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QIAN LIREN, SHEN JIANLIANG, CEN JIAN, YIN WENJIE, MA YUANYUAN. Myelodysplastic syndrome with neutrophilic panniculitis: A report of two cases and a literature review. Oncol Lett 2015; 9:1954-1956. [PMID: 25789075 PMCID: PMC4356265 DOI: 10.3892/ol.2015.2932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 01/22/2015] [Indexed: 11/05/2022] Open
Abstract
Myelodysplastic syndrome (MDS) associated with neutrophilic panniculitis (NP) is rare. To the best of our knowledge, there are only five previously reported cases of MDS associated with NP, consisting of four adults and a young male. The present study reviews the literature of the previously reported cases and presents two case reports of adult male patients who were initially diagnosed as MDS. The two patients presented with a sudden onset of fever without infection and erythematous indurated papules. The patients were diagnosed with NP by skin biopsy and their symptoms disappeared completely following treatment with systemic corticosteroids. NP may be an independent high-risk factor for MDS. However, due to the rarity of such cases, the exact pathogenesis of NP associated with MDS requires further investigation.
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West ES, Williams VL, Morelli JG. Vemurafenib-induced neutrophilic panniculitis in a child with a brainstem glioma. Pediatr Dermatol 2015; 32:153-4. [PMID: 24602192 DOI: 10.1111/pde.12316] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Neutrophilic panniculitis is a rare adverse effect of therapy with selective BRAF inhibitors. We report a case of neutrophilic panniculitis in a 15-year-old girl receiving treatment with vemurafenib for a brainstem glioma. Clinicians should be aware of this rare but important side effect of vemurafenib. This is the first report of neutrophilic panniculitis in a child treated with vemurafenib.
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Affiliation(s)
- Emily S West
- Columbia University College of Physicians and Surgeons, New York, New York
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16
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Nobeyama Y, Nakagawa H. Subcutaneous Sweet's syndrome and neutrophilic panniculitis. J Dermatol 2014; 41:861-2. [DOI: 10.1111/1346-8138.12586] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yoshimasa Nobeyama
- Department of Dermatology; The Jikei University School of Medicine; Tokyo Japan
| | - Hidemi Nakagawa
- Department of Dermatology; The Jikei University School of Medicine; Tokyo Japan
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17
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Wang C, Martin ME, Smith RE, DaCosta D, Levaka Veera R, Palazzo IE. A rare case of subcutaneous Sweet’s syndrome in a patient with chronic myelogenous leukemia: a case report and review of the literature. J Hematop 2014. [DOI: 10.1007/s12308-014-0206-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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18
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Zhang M, Hassan KM, Musiek A, Rosman IS. Ponatinib-induced neutrophilic panniculitis. J Cutan Pathol 2014; 41:597-601. [DOI: 10.1111/cup.12326] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 02/21/2014] [Accepted: 02/22/2014] [Indexed: 10/25/2022]
Affiliation(s)
- May Zhang
- School of Medicine; Washington University in St. Louis; Saint Louis MO USA
| | - Khaled M. Hassan
- Department of Pathology; Washington University in St. Louis; Saint Louis MO USA
| | - Amy Musiek
- Division of Dermatology; Washington University in St. Louis; Saint Louis MO USA
| | - Ilana S. Rosman
- Department of Pathology; Washington University in St. Louis; Saint Louis MO USA
- Division of Dermatology; Washington University in St. Louis; Saint Louis MO USA
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19
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Elston DM. Panniculitis. Dermatopathology (Basel) 2014. [DOI: 10.1016/b978-0-7020-5527-0.00016-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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20
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Prat L, Bouaziz JD, Wallach D, Vignon-Pennamen MD, Bagot M. Neutrophilic dermatoses as systemic diseases. Clin Dermatol 2013; 32:376-88. [PMID: 24767185 DOI: 10.1016/j.clindermatol.2013.11.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Neutrophilic dermatoses (ND) are inflammatory skin conditions characterized by a sterile infiltrate of normal polymorphonuclear leukocytes. The main clinical forms of ND include Sweet syndrome, pyoderma gangrenosum, erythema elevatum diutinum, subcorneal pustular dermatosis, and their atypical or transitional forms. ND are often idiopathic, but they may be associated with myeloid hematologic malignancies (Sweet syndrome), inflammatory bowel disease or rheumatoid arthritis (pyoderma gangrenosum), and monoclonal gammopathies (erythema elevatum diutinum, subcorneal pustular dermatosis). The possible infiltration of internal organs with neutrophils during the setting of ND underlies the concept of a neutrophilic systemic disease. ND may be seen as a polygenic autoinflammatory syndrome due to their frequent association with other autoinflammatory disorders (monogenic or polygenic) and the recent published efficacy of interleukin-1 blocking therapies in their management.
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Affiliation(s)
- Lola Prat
- Université Paris Diderot, Sorbonne Paris Cité; AP-HP, Paris, France; Service de Dermatologie et Service d'Anatomo-Pathologie, Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - Jean-David Bouaziz
- Université Paris Diderot, Sorbonne Paris Cité; AP-HP, Paris, France; Service de Dermatologie et Service d'Anatomo-Pathologie, Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France.
| | - Daniel Wallach
- Université Paris Diderot, Sorbonne Paris Cité; AP-HP, Paris, France; Service de Dermatologie et Service d'Anatomo-Pathologie, Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - Marie-Dominique Vignon-Pennamen
- Université Paris Diderot, Sorbonne Paris Cité; AP-HP, Paris, France; Service de Dermatologie et Service d'Anatomo-Pathologie, Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - Martine Bagot
- Université Paris Diderot, Sorbonne Paris Cité; AP-HP, Paris, France; Service de Dermatologie et Service d'Anatomo-Pathologie, Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France
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21
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Chan MP, Duncan LM, Nazarian RM. Subcutaneous Sweet syndrome in the setting of myeloid disorders: A case series and review of the literature. J Am Acad Dermatol 2013; 68:1006-15. [DOI: 10.1016/j.jaad.2012.12.954] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 10/28/2012] [Accepted: 12/03/2012] [Indexed: 11/16/2022]
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22
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Shin MK, Oh YJ, Yoon HJ, Lee MH. Subcutaneous Sweet syndrome with nuclear segmentation anomalies: a diagnostic marker of myelodysplasia. Int J Dermatol 2012; 51:976-8. [PMID: 22788818 DOI: 10.1111/j.1365-4632.2011.05103.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Min-Kyung Shin
- Department of Dermatology, School of Medicine, Kyung Hee University, Seoul, Korea
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Shah A, Jack A, Liu H, Hopkins RS. Neoplastic/paraneoplastic dermatitis, fasciitis, and panniculitis. Rheum Dis Clin North Am 2012; 37:573-92. [PMID: 22075198 DOI: 10.1016/j.rdc.2011.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The skin changes outlined in this article can be important clues to an underlying malignancy. Paraneoplastic dermatoses are skin disorders associated with an underlying neoplasm and whose course parallels that of the neoplasm. Recognizing these skin presentations leads to early diagnosis and management of the underlying malignancy. Effective treatment of the associated neoplasm often leads to improvement of the cutaneous manifestations and should be the primary focus of each patient's management.
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Affiliation(s)
- Anjali Shah
- Division of Dermatology, Department of Medicine, Loyola University Medical Center, Room 101, Building 54, 2160 South First Avenue, Maywood, IL 60153, USA
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24
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Panniculite neutrophilique récidivante chez une patiente traitée par imatinib mésilate puis dasatinib pour une leucémie myéloïde chronique. Ann Dermatol Venereol 2011; 138:135-9. [DOI: 10.1016/j.annder.2010.11.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2010] [Revised: 10/29/2010] [Accepted: 11/17/2010] [Indexed: 11/23/2022]
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25
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Soutou B, Vignon-Pennamen D, Chosidow O. [Neutrophilic dermatoses]. Rev Med Interne 2010; 32:306-13. [PMID: 20933309 DOI: 10.1016/j.revmed.2010.08.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Revised: 01/23/2010] [Accepted: 08/25/2010] [Indexed: 01/13/2023]
Abstract
Neutrophilic dermatoses are inflammatory disorders where normal neutrophils infiltrate the skin without infection. Sweet's syndrome, pyoderma gangrenosum, subcorneal pustulosis, erythema elevatum diutinum and a few other conditions are included in the spectrum of neutrophilic dermatoses. In addition to their typical presentation, atypical and overlap forms of these disorders may be observed. According to the location of the neutrophilic infiltrate, three clinical forms are distinguished: superficial (epidermal), en plaques (dermal) and deep (dermal and hypodermal). During the disease course, other tissues can be affected by the same neutrophilic infiltrate. An association with other systemic diseases including malignant blood disorders, inflammatory bowel diseases and autoimmune disorders is frequent. The mechanisms leading to the invasion of the skin by neutrophils remains not completely elucidated. Treatment depends on the intensity and the acute or chronic form of the disease. In acute and severe forms, systemic corticosteroids are first-line therapy, whereas colchicine, dapsone, and even topical corticosteroids could be used in milder presentations of the disease.
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Affiliation(s)
- B Soutou
- Centre hospitalier du Nord, 100, Jdeidet, Zgharta, Liban
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26
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Barco D, Barnadas MA, Roé E, Sancho FJ, Ricart E, Alomar A. Neutrophilic dermatoses in a patient with collagenous colitis. Dermatol Reports 2010; 2:e5. [PMID: 25386241 PMCID: PMC4211476 DOI: 10.4081/dr.2010.e5] [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: 09/16/2009] [Revised: 01/22/2010] [Accepted: 01/22/2010] [Indexed: 11/23/2022] Open
Abstract
We report the case of a 75-year old woman with collagenous colitis who presented with erythematous and edematous plaques on the periorbital and eyelid regions, accompanied by oral ulcers. Histopathology showed a dermal neutrophilic infiltrate plus mild septal and lobular panniculitis with lymphocytes, neutrophils and eosinophils. Five years earlier she had presented a flare of papules and vesicles on the trunk, together with oral ulcers; a skin biopsy revealed a neutrophilic dermal infiltrate and Sweet’s syndrome was diagnosed. Both the neutrophilic panniculitis and the Sweet’s syndrome were accompanied by fever, malaise and diarrhea. Cutaneous and intestinal symptoms disappeared with corticoid therapy. The two types of neutrophilic dermatoses that appeared in periods of colitis activity suggest that intestinal and cutaneous manifestations may be related.
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Affiliation(s)
| | | | | | | | - Elena Ricart
- Department of Digestive Diseases, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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27
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Al-Niaimi F, Clark C, Thorrat A, Burden AD. Idiopathic lobular panniculitis: remission induced and maintained with infliximab. Br J Dermatol 2009; 161:691-2. [PMID: 19519831 DOI: 10.1111/j.1365-2133.2009.09295.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Hendrickx G, Nooijen P, De Raeve L. Panniculitis as the presenting sign of a myelodysplastic syndrome in an adolescent boy. Pediatr Dermatol 2009; 26:219-22. [PMID: 19419479 DOI: 10.1111/j.1525-1470.2009.00885.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Panniculitis is an uncommon condition in childhood and may prove difficult to diagnose both clinically and histologically. The clinical spectrum is similar to that in adults and has been associated with many primary diseases. Noninfectious causes are less common in children than in adults. The pathogenesis remains uncertain in a significant number of children. In some it may be a malignant, unremitting disease which can be fatal. We present a boy aged 13 years with panniculitis of the right foot as presenting sign for the ultimate diagnosis myelodysplasia-acute myeloid leukemia. To our knowledge this is the first report on a young boy.
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Affiliation(s)
- Guy Hendrickx
- Department of Paediatrics, Sint Anna Clinic, Bogardeind, Geldrop, The Netherlands.
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29
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Elston DM. Panniculitis. Dermatopathology (Basel) 2009. [DOI: 10.1016/b978-0-7020-3023-9.10016-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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31
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Dyer JA, Guitart J, Klein-Gitelman M, Mancini AJ. Neutrophilic panniculitis in infancy: A cutaneous manifestation of juvenile rheumatoid arthritis. J Am Acad Dermatol 2007; 57:S65-8. [DOI: 10.1016/j.jaad.2005.11.1101] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2005] [Revised: 11/21/2005] [Accepted: 11/30/2005] [Indexed: 11/28/2022]
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Cohen PR. Sweet's syndrome--a comprehensive review of an acute febrile neutrophilic dermatosis. Orphanet J Rare Dis 2007; 2:34. [PMID: 17655751 PMCID: PMC1963326 DOI: 10.1186/1750-1172-2-34] [Citation(s) in RCA: 490] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2007] [Accepted: 07/26/2007] [Indexed: 01/19/2023] Open
Abstract
Sweet's syndrome (the eponym for acute febrile neutrophilic dermatosis) is characterized by a constellation of clinical symptoms, physical features, and pathologic findings which include fever, neutrophilia, tender erythematous skin lesions (papules, nodules, and plaques), and a diffuse infiltrate consisting predominantly of mature neutrophils that are typically located in the upper dermis. Several hundreds cases of Sweet's syndrome have been published. Sweet's syndrome presents in three clinical settings: classical (or idiopathic), malignancy-associated, and drug-induced. Classical Sweet's syndrome (CSS) usually presents in women between the age of 30 to 50 years, it is often preceded by an upper respiratory tract infection and may be associated with inflammatory bowel disease and pregnancy. Approximately one-third of patients with CSS experience recurrence of the dermatosis. The malignancy-associated Sweet's syndrome (MASS) can occur as a paraneoplastic syndrome in patients with an established cancer or individuals whose Sweet's syndrome-related hematologic dyscrasia or solid tumor was previously undiscovered; MASS is most commonly related to acute myelogenous leukemia. The dermatosis can precede, follow, or appear concurrent with the diagnosis of the patient's cancer. Hence, MASS can be the cutaneous harbinger of either an undiagnosed visceral malignancy in a previously cancer-free individual or an unsuspected cancer recurrence in an oncology patient. Drug-induced Sweet's syndrome (DISS) most commonly occurs in patients who have been treated with granulocyte-colony stimulating factor, however, other medications may also be associated with DISS. The pathogenesis of Sweet's syndrome may be multifactorial and still remains to be definitively established. Clinical and laboratory evidence suggests that cytokines have an etiologic role. Systemic corticosteroids are the therapeutic gold standard for Sweet's syndrome. After initiation of treatment with systemic corticosteroids, there is a prompt response consisting of dramatic improvement of both the dermatosis-related symptoms and skin lesions. Topical application of high potency corticosteroids or intralesional corticosteroids may be efficacious for treating localized lesions. Other first-line oral systemic agents are potassium iodide and colchicine. Second-line oral systemic agents include indomethacin, clofazimine, cyclosporine, and dapsone. The symptoms and lesions of Sweet's syndrome may resolved spontaneously, without any therapeutic intervention; however, recurrence may follow either spontaneous remission or therapy-induced clinical resolution.
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Affiliation(s)
- Philip R Cohen
- University of Houston Health Center, Houston, Texas, USA.
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33
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Neoh CY, Tan AWH, Ng SK. Sweet's syndrome: a spectrum of unusual clinical presentations and associations. Br J Dermatol 2007; 156:480-5. [PMID: 17300237 DOI: 10.1111/j.1365-2133.2006.07677.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sweet's syndrome (SS) is the prototypic neutrophilic dermatosis. First described in 1964, the characterization of new clinical associations, unique histopathological findings and clinical variants have stimulated much interest and discussion recently. However, the prevalence of these unusual variants and clinical associations within a single cohort of patients, has not been described. OBJECTIVES To describe and evaluate the prevalence of unusual clinical and histopathological features, as well as the clinical associations of SS seen in patients from the National Skin Centre, Singapore. METHODS This is a retrospective study of all consecutive cases of SS seen at our centre over a 5.5-year period (June 1999-December 2004). Data on associated systemic diseases was obtained from the medical records and matched with information from the National Cancer Registry, Singapore. Patients not actively followed up for more than 3 months were contacted for their updated health status. RESULTS Thirty-seven patients were identified. Ten (27%) had non-idiopathic SS. These were associated with haematological disorders, connective tissue disorders, infections or a drug. Twenty-nine patients (78%) had at least one atypical clinical or histopathological feature. Atypical clinical features included bullous lesions, SS with hand involvement or neutrophilic dermatoses of the hands and the concomitant existence of subcutaneous SS with pyoderma gangrenosum. SS was the presenting feature in three patients with infections caused by atypical organisms, including Mycobacterium chelonae, Penicillium species and Salmonella type D. Unique histopathological variants included subcutaneous SS and lesions containing an admixture of mature and immature neutrophils. Subcutaneous neutrophilic inflammation seemed to be more common in patients with an underlying haematological disorder. This group of patients also had a lower mean haemoglobin level. CONCLUSIONS Unusual clinical and histopathological variants of SS described in the literature are similarly encountered in our cohort of patients, with some features being more common than others. We highlight and discuss some unique clinical and histopathological observations seen in our patients with SS.
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Affiliation(s)
- C Y Neoh
- National Skin Centre, 1 Mandalay Road, Singapore, Singapore.
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Raj K, Ho A, Creamer JD, du Vivier AWP, Salisbury JR, Mufti GJ. Complete response of deep neutrophilic dermatosis associated with myelodysplastic syndrome to 5-azacytidine. Br J Dermatol 2007; 156:1039-41. [PMID: 17408390 DOI: 10.1111/j.1365-2133.2007.07831.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cutaneous manifestations of myelodysplastic syndromes (MDS) may predict disease progression and a poorer prognosis. We describe a patient in whom a deep neutrophilic dermatosis preceded evolution of disease from refractory anaemia to RAEB (refractory anaemia with excess blasts) and resolved completely on treating the disease with 5-azacytidine. The dermatological response was accompanied by complete bone marrow remission and trilineage haematological improvement. We suggest that 5-azacytidine should be considered in the treatment of immune mediated cutaneous manifestations of MDS.
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Affiliation(s)
- K Raj
- Department of Haematological Medicine, King's College London and King's College Hospital, Denmark Hill, London, UK
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35
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Ginarte M, Toribio J. Sweet's syndrome and erythema nodosum: two neutrophilic dermatoses? Clin Rheumatol 2007; 26:1215-6. [PMID: 17294051 DOI: 10.1007/s10067-007-0564-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Accepted: 01/19/2007] [Indexed: 10/23/2022]
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Abstract
Specific and nonspecific panniculitis may occur during the course of connective tissue diseases. However, association of panniculitis and rheumatoid arthritis has only rarely been described, and with so few reports, it is difficult to know the significance of this unusual association. We describe 2 patients with rheumatoid arthritis and features of Sjögren syndrome in whom panniculitis developed during the course of the disease. Histologic confirmation of septal panniculitis was established in one case and the panniculitis in this case improved as the arthritis resolved.
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Affiliation(s)
- Yin-Cih Chao
- Section of Allergy, Immunology and Rheumatology, Department of Medicine, Veterans General Hospital, and the Department of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
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Cohen PR. Subcutaneous Sweet's syndrome: a variant of acute febrile neutrophilic dermatosis that is included in the histopathologic differential diagnosis of neutrophilic panniculitis. J Am Acad Dermatol 2006; 52:927-8. [PMID: 15858502 DOI: 10.1016/j.jaad.2005.03.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Kerl K, Masouyé I, Lesavre P, Saurat JH, Borradori L. A Case of Amicrobial Pustulosis of the Folds Associated with Neutrophilic Gastrointestinal Involvement in Systemic Lupus Erythematosus. Dermatology 2005; 211:356-9. [PMID: 16286747 DOI: 10.1159/000088508] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2004] [Accepted: 02/12/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Amicrobial pustulosis of the folds is a recently described entity characterized by relapsing pustular lesions involving predominantly the cutaneous folds and the scalp. The disease typically occurs in the context of an autoimmune or systemic disease and should be included within the spectrum of neutrophilic dermatoses. OBSERVATION We describe a patient with a history of systemic lupus erythematosus, who developed amicrobial pustulosis of the folds. Strikingly, the patient also exhibited recurrent oral and gastrointestinal manifestations that paralleled the course of the cutaneous signs. CONCLUSIONS Our observation indicates that, in analogy to the other neutrophilic dermatoses, amicrobial pustulosis of the folds can also be complicated by the development of extracutaneous neutrophilic involvement, knowledge of which is critical for its diagnosis and proper management.
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Affiliation(s)
- K Kerl
- Department of Dermatology, University Medical School, Geneva, Switzerland
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39
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Walling H, Geraminejad P. Determine alpha-1 antitrypsin level and phenotype in patients with neutrophilic panniculitis. J Am Acad Dermatol 2005; 52:373-4. [PMID: 15692496 DOI: 10.1016/j.jaad.2004.07.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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40
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Wallach D. Les dermatoses neutrophiliques. Rev Med Interne 2005; 26:41-53. [DOI: 10.1016/j.revmed.2004.06.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2004] [Accepted: 06/17/2004] [Indexed: 11/24/2022]
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