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Malvárez Martín-Aragón C, Gutiérrez-Meré R, Vázquez-Temprano N. Sweet syndrome after vaccination. Med Clin (Barc) 2024:S0025-7753(24)00484-6. [PMID: 39271444 DOI: 10.1016/j.medcli.2024.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 06/26/2024] [Accepted: 07/01/2024] [Indexed: 09/15/2024]
Affiliation(s)
| | - Raúl Gutiérrez-Meré
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, España; DIPO Grupo de investigación, Instituto de investigación de la salud Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Vigo, España
| | - Nuria Vázquez-Temprano
- Servicio de Medicina Interna, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, España
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2
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Hrin ML, Huang WW. Sweet Syndrome and Neutrophilic Dermatosis of the Dorsal Hands. Dermatol Clin 2024; 42:193-207. [PMID: 38423681 DOI: 10.1016/j.det.2023.08.007] [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
Sweet syndrome is a rare cutaneous condition with a broad clinical differential diagnosis. It can be classified into 3 subtypes: classic, malignancy-associated, and drug-induced. There are numerous associated disorders and provoking medications. Uncommonly, it can present as a multiorgan disease and cause significant morbidity. Systemic corticosteroids are the gold standard of treatment and yield rapid improvements in both lesions and symptoms. Nonsteroidal therapies may be effective alternatives, although high-quality comparative data are lacking. Some treatments for Sweet syndrome have paradoxically been implicated in the induction of disease.
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Affiliation(s)
- Matthew L Hrin
- Department of Dermatology, Wake Forest School of Medicine, Medical Center Boulevard, 4618 Country Club Road, Winston-Salem, NC 27157-1071, USA.
| | - William W Huang
- Department of Dermatology, Wake Forest School of Medicine, 4618 Country Club Road, Winston-Salem, NC 27104, USA
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3
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Baker O, Chen KS, Kaminska I, Rajagopal V. Sweet syndrome following the ChAdOx1-S vaccine. BMJ Case Rep 2024; 17:e257635. [PMID: 38216167 PMCID: PMC10806861 DOI: 10.1136/bcr-2023-257635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024] Open
Abstract
We report a case of vaccine-induced Sweet syndrome in a female patient in her 50s presenting with fevers and a scattered red patchy rash on the lower limbs. Seven days prior, she had received the first dose of AstraZeneca ChAdOx1-S vaccine. A skin biopsy confirmed Sweet syndrome. She did not respond to high doses of prednisolone and required methotrexate therapy to induce remission. This is one of the first reports of Sweet syndrome caused by the ChAdOx1-S vaccine and provides further evidence for vaccine-induced dermatosis. This case demonstrates that methotrexate can induce remission in cases of Sweet syndrome resistant to corticosteroids. This report also describes an approach to the differential diagnosis of patients presenting with a rash, fever and malaise.
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Affiliation(s)
- Olivia Baker
- General Medicine, West Suffolk Hospitals NHS Trust, Bury Saint Edmunds, Suffolk, UK
| | - Kun Sen Chen
- Dermatology, West Suffolk Hospitals NHS Trust, Bury Saint Edmunds, Suffolk, UK
| | - Iwona Kaminska
- Pathology, West Suffolk Hospitals NHS Trust, Bury Saint Edmunds, Suffolk, UK
| | - Vivek Rajagopal
- General Medicine, West Suffolk Hospitals NHS Trust, Bury Saint Edmunds, Suffolk, UK
- Rheumatology, West Suffolk Hospitals NHS Trust, Bury Saint Edmunds, Suffolk, UK
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4
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Kim MJ, Kim JW, Na J. Sweet syndrome after the first dose of SARS-CoV-2 vaccine (Pfizer-BioNTech). Dermatol Ther 2022; 35:e15915. [PMID: 36209375 PMCID: PMC9874510 DOI: 10.1111/dth.15915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/06/2022] [Accepted: 10/06/2022] [Indexed: 01/28/2023]
Affiliation(s)
- Min Jae Kim
- Department of DermatologySeoul National University, Bundang HospitalSeongnamRepublic of Korea
| | - Jee Woo Kim
- Department of DermatologySeoul National University, Bundang HospitalSeongnamRepublic of Korea
| | - Jung‐Im Na
- Department of DermatologySeoul National University, Bundang HospitalSeongnamRepublic of Korea
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5
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Bechtold A, Owczarczyk‐Saczonek A. Atypical presentation of Sweet syndrome with nodular erythema and oral ulcerations provoked by Ad26.COV2.S SARS-CoV-2 vaccination and review of literature. Dermatol Ther 2022; 35:e15923. [PMID: 36219526 PMCID: PMC9874627 DOI: 10.1111/dth.15923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/05/2022] [Accepted: 10/08/2022] [Indexed: 01/27/2023]
Abstract
The aim of this article is to present the case of acute febrile neutrophilic dermatosis (Sweet syndrome-SS) after Ad26.COV2.S vaccination against SARS-CoV-2. To the best of our knowledge, this is the second case of SS provoked by this specific vaccine. What is more, the mildly symptomatic beginning of the disease, later followed by typical SS manifestation with a variety of symptoms including nodular erythema of the feet and oral ulcerations, made it very challenging to establish the diagnosis. The article focuses on the current literature on the acute febrile neutrophilic dermatosis, along with the coexistence with other neutrophilic dermatoses and anti-SARS-CoV-2 vaccinations as provoking factors. It emphasizes the necessity for sharing the knowledge and experience on the subject of SS's clinical manifestations and underlying causes to facilitate prompt diagnosis and introduction of appropriate treatment.
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Affiliation(s)
- Agata Bechtold
- Dermatology, Sexually Transmitted Diseases and Clinical Immunology ClinicThe Municipal Polyclinical Hospital in OlsztynOlsztynPoland
- Department of Psychodermatology, Department of Pulmonology, Rheumatology and Clinical ImmunologyMedical University of LodzLodzPoland
| | - Agnieszka Owczarczyk‐Saczonek
- Department and Clinic of Dermatology, Sexually Transmitted Diseases and Clinical ImmunologyUniveristy of Warmia and Mazury in OlsztynOlsztynPoland
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6
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Ben Salah N, Korbi M, Ben Fadhel N, Safa I, Chad F, Njima M, Belhadjali H, Amri M, Aouem K, Zili J. Sweet Syndrome following SARS-CoV-2 CoronaVac vaccine. J Eur Acad Dermatol Venereol 2022; 36:e873-e875. [PMID: 35723896 PMCID: PMC9350371 DOI: 10.1111/jdv.18336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Nesrine Ben Salah
- Dermatology department, Fattouma Bourguiba Hospital, Dermo-Respiratory Research Laboratory UR14 SP 03,University of Medicine, Monastir, Tunisia
| | - Mouna Korbi
- Dermatology department, Fattouma Bourguiba Hospital, Dermo-Respiratory Research Laboratory UR14 SP 03,University of Medicine, Monastir, Tunisia
| | - Najeh Ben Fadhel
- Pharmacology department, Fattouma Bourguiba Hospital, University of Medicine, Monastir, Tunisia
| | - Idoudi Safa
- Dermatology department, Fattouma Bourguiba Hospital, Dermo-Respiratory Research Laboratory UR14 SP 03,University of Medicine, Monastir, Tunisia
| | - Ferdaous Chad
- Pharmacology department, Fattouma Bourguiba Hospital, University of Medicine, Monastir, Tunisia
| | - Manel Njima
- Anatomopathology department, Fattouma Bourguiba Hospital, University of Medicine, Monastir, Tunisia
| | - Hichem Belhadjali
- Dermatology department, Fattouma Bourguiba Hospital, Dermo-Respiratory Research Laboratory UR14 SP 03,University of Medicine, Monastir, Tunisia
| | - Montassar Amri
- Dermatology department, Fattouma Bourguiba Hospital, Dermo-Respiratory Research Laboratory UR14 SP 03,University of Medicine, Monastir, Tunisia
| | - Karim Aouem
- Pharmacology department, Fattouma Bourguiba Hospital, University of Medicine, Monastir, Tunisia
| | - Jameleddine Zili
- Dermatology department, Fattouma Bourguiba Hospital, Dermo-Respiratory Research Laboratory UR14 SP 03,University of Medicine, Monastir, Tunisia
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7
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Pelchat F, Fournier C, Perron E, Gilbert M, Delisle B. Sweet syndrome following Moderna COVID-19 vaccine: A case report. SAGE Open Med Case Rep 2022; 10:2050313X221117884. [PMID: 35991953 PMCID: PMC9382060 DOI: 10.1177/2050313x221117884] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
With the COVID-19 pandemic, vaccines have been administered all around the world probably
more than ever. Even though they are considered safe, with such a huge quantity of doses
used, many adverse effects including cutaneous ones were reported. We report here the case
of a male adult with a history of monoclonal gammopathy of undetermined significance who
presented with an extensive cutaneous eruption of indurated erythematous papules and
plaques 2 days after receiving his first dose of Moderna COVID-19 vaccine (mRNA-1273
SARS-CoV-2 vaccine). Histopathology was compatible with a histiocytoid Sweet syndrome and
history suggested that the vaccine contributed to the eruption.
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Affiliation(s)
- Frederic Pelchat
- Department of Dermatology, CHU de Québec, Laval University, Québec, QC, Canada
| | - Cynthia Fournier
- Department of Dermatology, CHU de Québec, Laval University, Québec, QC, Canada
| | - Emilie Perron
- Department of Pathology, CHU de Québec, Laval University, Québec, QC, Canada
| | - Martin Gilbert
- Department of Dermatology, CHU de Québec, Laval University, Québec, QC, Canada
| | - Bernard Delisle
- Department of Dermatology, CHU de Québec, Laval University, Québec, QC, Canada
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8
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Aquino MR, Bingemann TA, Nanda A, Maples KM. Delayed allergic skin reactions to vaccines. Allergy Asthma Proc 2022; 43:20-29. [PMID: 34983706 DOI: 10.2500/aap.2022.43.210105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Recent advances in vaccination against the severe acute respiratory syndrome coronavirus 2 pandemic have brought allergists and dermatologists to the forefront because both immediate and delayed hypersensitivity reactions have been reported. Objective: This literature review focused on delayed reactions to vaccines, including possible causative agents and practical information on how to diagnose, evaluate with patch testing, and manage subsequent dose administration. Methods: Currently published reviews and case reports in PubMed, along with data on vaccines from the Centers for Disease Control and Prevention web site. Relevant case reports and reviews that focused on delayed reactions to vaccines were selected. Results: Most delayed hypersensitivity reactions to vaccines include cutaneous manifestations, which vary from local persistent pruritic nodules to systemic rashes. The onset is usually within a few days but can be delayed by weeks. Multiple excipients have been identified that have been implicated in delayed vaccine reactions, including thimerosal, formaldehyde, aluminum, antibiotics, and gelatin. Treatment with antihistamines, topical corticosteroids, or systemic corticosteroids alleviates symptoms in most patients. Such reactions are generally not contraindications to future vaccination. However, for more-severe reactions, patch testing for causative agents can be used to aid in diagnosis and approach further vaccination. Conclusion: Delayed-type hypersensitivity reactions to vaccines are not uncommon. If needed, patch testing can be used to confirm agents, including antibiotics, formaldehyde, thimerosal, and aluminum. In most cases, delayed cutaneous reactions are not contraindications to further vaccine administration.
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Affiliation(s)
- Marcella R. Aquino
- From the Allergy and Immunology Section, Department of Pediatrics, Hasbro Children's Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Theresa A. Bingemann
- Divisions of Allergy, Immunology and Rheumatology and Pediatric Allergy and Immunology, University of Rochester, Rochester, Newyork
| | - Anil Nanda
- Asthma and Allergy Center, Lewisville and Flower Mound, Texas, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Texas; and
| | - Kelly M. Maples
- Eastern Virginia Medical School, Children's Hospital of The King's Daughters, Virginia
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9
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Sweet Syndrome Following SARS-CoV2 Vaccination. Vaccines (Basel) 2021; 9:vaccines9111212. [PMID: 34835143 PMCID: PMC8622799 DOI: 10.3390/vaccines9111212] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/16/2021] [Accepted: 10/16/2021] [Indexed: 01/14/2023] Open
Abstract
Vaccines are today considered one of the most effective means against the Sars-CoV-2 pandemic. The BNT162b2 vaccine by Pfizer/BioNTech has been massively administered throughout the globe; since its approval, a wide spectrum of cutaneous reactions has been reported. Here we report the case of a 52-year-old Caucasian male who presented with an acute febrile eruption that arose 72 h after the first dose of the BNT162b2 vaccine. The clinicopathological findings were consistent with Sweet's syndrome. The short latency time suggested a possible role of the vaccine in triggering Sweet's syndrome in this case.
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10
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Niebel D, Wenzel J, Wilsmann-Theis D, Ziob J, Wilhelmi J, Braegelmann C. Single-Center Clinico-Pathological Case Study of 19 Patients with Cutaneous Adverse Reactions Following COVID-19 Vaccines. Dermatopathology (Basel) 2021; 8:463-476. [PMID: 34698094 PMCID: PMC8544472 DOI: 10.3390/dermatopathology8040049] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/15/2021] [Accepted: 09/22/2021] [Indexed: 01/13/2023] Open
Abstract
(1) Background: Coronavirus disease 2019 (COVID-19) vaccines are currently employed on a population-wide scale in most countries worldwide. Data about unusual cutaneous adverse drug reactions (ADR) are scant, though. (2) Methods: We retrospectively analyzed moderate to severe vaccine-related ADR in the Department of Dermatology and Allergy of the University Hospital Bonn between May to June 2021 and analyzed related skin biopsies. (3) Results: As a specialized dermatological academic center, we encountered a total of n = 19 clinically and pathologically heterogeneous cutaneous ADR with a female predominance. Delayed cutaneous ADR occurred as late as 30 days after vaccination. The majority of ADR were mild, though a few patients required systemic treatment (antihistamines, glucocorticosteroids). (4) Conclusions: The clinico-pathological spectrum of cutaneous side effects with COVID-19 vaccines is wide; however, the benefits outweigh the risks by far. More dermatopathological studies on cutaneous ADR not limited to COVID-19 vaccines are desirable to enable a better understanding of underlying pathophysiological mechanisms.
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Affiliation(s)
- Dennis Niebel
- Department of Dermatology and Allergy, University Hospital Bonn, 53127 Bonn, Germany; (J.W.); (D.W.-T.); (J.Z.); (J.W.); (C.B.)
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11
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Niebel D, Novak N, Wilhelmi J, Ziob J, Wilsmann-Theis D, Bieber T, Wenzel J, Braegelmann C. Cutaneous Adverse Reactions to COVID-19 Vaccines: Insights from an Immuno-Dermatological Perspective. Vaccines (Basel) 2021; 9:944. [PMID: 34579181 PMCID: PMC8470727 DOI: 10.3390/vaccines9090944] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 02/07/2023] Open
Abstract
(1) Background: Numerous vaccines are under preclinical and clinical development for prevention of severe course and lethal outcome of coronavirus disease 2019 (COVID-19). In light of high efficacy rates and satisfactory safety profiles, some agents have already reached approval and are now distributed worldwide, with varying availability. Real-world data on cutaneous adverse drug reactions (ADRs) remain limited. (2) Methods: We performed a literature research concerning cutaneous ADRs to different COVID-19 vaccines, and incorporated our own experiences. (3) Results: Injection site reactions are the most frequent side effects arising from all vaccine types. Moreover, delayed cutaneous ADRs may occur after several days, either as a primary manifestation or as a flare of a pre-existing inflammatory dermatosis. Cutaneous ADRs may be divided according to their cytokine profile, based on the preponderance of specific T-cell subsets (i.e., Th1, Th2, Th17/22, Tregs). Specific cutaneous ADRs mimic immunogenic reactions to the natural infection with SARS-CoV-2, which is associated with an abundance of type I interferons. (4) Conclusions: Further studies are required in order to determine the best suitable vaccine type for individual groups of patients, including patients suffering from chronic inflammatory dermatoses.
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Affiliation(s)
- Dennis Niebel
- Department of Dermatology and Allergy, University Hospital Bonn, 53127 Bonn, Germany; (N.N.); (J.W.); (J.Z.); (D.W.-T.); (T.B.); (J.W.); (C.B.)
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12
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Alpalhão M, Maia-Silva J, Filipe P. Severe Acute Respiratory Syndrome Coronavirus 2 Vaccines and Cutaneous Adverse Reactions: A Review. Dermatitis 2021; 32:133-139. [PMID: 33851937 DOI: 10.1097/der.0000000000000755] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We are entering a new stage of the severe acute respiratory syndrome coronavirus 2 pandemic with the initiation of large-scale vaccination programs globally. In these circumstances, even rare adverse effects of vaccines may be encountered more often, if millions of people are to be vaccinated in a short period. Vaccination has the potential for causing cutaneous adverse effects. Thus, it is paramount that dermatologists worldwide are acquainted with the possible skin reaction patterns to the coming vaccines. Herein, we conduct a review to discuss the most frequent cutaneous adverse effects of vaccines and their management, with a particular focus on the expected adverse reactions for the coming severe acute respiratory syndrome coronavirus 2 vaccines, such as local reactions, as well as immediate- and delayed-type hypersensitivity reactions, including erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrosis, serum sickness-like reactions, and vasculitides. We also discuss the yet unanswered questions on vaccines for which we may soon be asked to provide an expert opinion.
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13
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Lalor LE, Chiu YE. Rare Vesiculopustular Eruptions of the Neonatal Period. Clin Perinatol 2020; 47:53-75. [PMID: 32000929 DOI: 10.1016/j.clp.2019.09.005] [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: 11/28/2022]
Abstract
Numerous disorders present with vesiculopustular eruptions in the neonatal period, ranging from benign to life-threatening. Accurate and prompt diagnosis is imperative to avoid unnecessary testing and treatment for benign eruptions, while allowing for adequate treatment of potentially fatal disorders. In this review, we highlight several rare blistering diseases of the newborn. A diagnostic approach is outlined to provide clinicians with a framework for approaching a neonate with vesicles, pustules, or ulcers.
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Affiliation(s)
- Leah E Lalor
- Department of Dermatology (Pediatric Dermatology), Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA; Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
| | - Yvonne E Chiu
- Department of Dermatology (Pediatric Dermatology), Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA; Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
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14
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Stone CA, Rukasin CR, Beachkofsky TM, Phillips EJ. Immune-mediated adverse reactions to vaccines. Br J Clin Pharmacol 2019; 85:2694-2706. [PMID: 31472022 PMCID: PMC6955412 DOI: 10.1111/bcp.14112] [Citation(s) in RCA: 126] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 07/26/2019] [Accepted: 08/14/2019] [Indexed: 02/06/2023] Open
Abstract
Vaccination continues to be the single most important and successful public health intervention, due to its prevention of morbidity and mortality from prevalent infectious diseases. Severe immunologically mediated reactions are rare and less common with the vaccine than the true infection. However, these events can cause public fearfulness and loss of confidence in the safety of vaccination. In this paper, we perform a systematic literature search and narrative review of immune-mediated vaccine adverse events and their known and proposed mechanisms, and outline directions for future research. Improving our knowledge base of severe immunologically mediated vaccine reactions and their management drives better vaccine safety and efficacy outcomes.
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Affiliation(s)
- Cosby A. Stone
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of MedicineVanderbilt University School of MedicineNashvilleTennesseeUSA
| | - Christine R.F. Rukasin
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of MedicineVanderbilt University School of MedicineNashvilleTennesseeUSA
| | | | - Elizabeth J. Phillips
- Department of MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
- Vanderbilt University Medical SchoolNashvilleTennessee
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15
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Heath MS, Ortega-Loayza AG. Insights Into the Pathogenesis of Sweet's Syndrome. Front Immunol 2019; 10:414. [PMID: 30930894 PMCID: PMC6424218 DOI: 10.3389/fimmu.2019.00414] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 02/15/2019] [Indexed: 12/15/2022] Open
Abstract
Sweet's syndrome, also known as Acute Febrile Neutrophilic Dermatosis, is a rare inflammatory condition. It is considered to be the prototype disease of neutrophilic dermatoses, and presents with acute onset dermal neutrophilic lesions, leukocytosis, and pyrexia. Several variants have been described both clinically and histopathologically. Classifications include classic Sweet's syndrome, malignancy associated, and drug induced. The cellular and molecular mechanisms involved in Sweet's syndrome have been difficult to elucidate due to the large variety of conditions leading to a common clinical presentation. The exact pathogenesis of Sweet's syndrome is unclear; however, new discoveries have shed light on the role of inflammatory signaling, disease induction, and relationship with malignancy. These findings include an improved understanding of inflammasome activation, malignant transformation into dermal infiltrating neutrophils, and genetic contributions. Continued investigations into effective treatments and targeted therapy will benefit patients and improve our molecular understanding of inflammatory diseases, including Sweet's syndrome.
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Affiliation(s)
- Michael S Heath
- Oregon Health and Science University, Department of Dermatology, Portland, OR, United States
| | - Alex G Ortega-Loayza
- Oregon Health and Science University, Department of Dermatology, Portland, OR, United States
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16
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Nelson CA, Stephen S, Ashchyan HJ, James WD, Micheletti RG, Rosenbach M. Neutrophilic dermatoses: Pathogenesis, Sweet syndrome, neutrophilic eccrine hidradenitis, and Behçet disease. J Am Acad Dermatol 2018; 79:987-1006. [PMID: 29653210 DOI: 10.1016/j.jaad.2017.11.064] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/06/2017] [Accepted: 11/08/2017] [Indexed: 12/24/2022]
Abstract
Neutrophilic dermatoses are a heterogeneous group of inflammatory skin disorders that present with unique clinical features but are unified by the presence of a sterile, predominantly neutrophilic infiltrate on histopathology. The morphology of cutaneous lesions associated with these disorders is heterogeneous, which renders diagnosis challenging. Moreover, a thorough evaluation is required to exclude diseases that mimic these disorders and to diagnose potential associated infectious, inflammatory, and neoplastic processes. While some neutrophilic dermatoses may resolve spontaneously, most require treatment to achieve remission. Delays in diagnosis and treatment can lead to significant patient morbidity and even mortality. Therapeutic modalities range from systemic corticosteroids to novel biologic agents, and the treatment literature is rapidly expanding. The first article in this continuing medical education series explores the pathogenesis of neutrophilic dermatoses and reviews the epidemiology, clinical and histopathologic features, diagnosis, and management of Sweet syndrome, neutrophilic eccrine hidradenitis, and Behçet disease.
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Affiliation(s)
- Caroline A Nelson
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sasha Stephen
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hovik J Ashchyan
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - William D James
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert G Micheletti
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Misha Rosenbach
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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17
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Abstract
Sweet syndrome, also known as acute febrile neutrophilic dermatosis, is an uncommon inflammatory disorder marked by fever and swelling of the skin that can be very painful. It is especially rare in the pediatric population. Infection is a well-known trigger for Sweet syndrome, but this entity has, to our knowledge, never been described after Mycoplasma infection. Herein, we describe the first pediatric case of febrile neutrophilic dermatosis associated with Mycoplasma infection.
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Affiliation(s)
- Jackie Hsieh
- Hasbro Children's Hospital, Warren Alpert Medical School at Brown University, Providence, Rhode Island
| | - Ali Yalcindag
- Hasbro Children's Hospital, Warren Alpert Medical School at Brown University, Providence, Rhode Island
| | - Daniel T Coghlin
- Hasbro Children's Hospital, Warren Alpert Medical School at Brown University, Providence, Rhode Island
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18
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SÍNDROME DE SWEET DESENCADEADA POR VACINA DE HEPATITE B. REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2017.07.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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19
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Cohen PR. Injection Site Lichenoid Dermatitis Following Pneumococcal Vaccination: Report and Review of Cutaneous Conditions Occurring at Vaccination Sites. Dermatol Ther (Heidelb) 2016; 6:287-98. [PMID: 26988991 PMCID: PMC4906099 DOI: 10.1007/s13555-016-0105-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Indexed: 11/30/2022] Open
Abstract
Background Cutaneous dermatoses and malignancies have occurred at the sites of vaccines. Purpose To describe a man who developed a lichenoid dermatitis at the pneumococcal vaccine injection site and to review cutaneous dermatoses and malignancies occurring at vaccination sites. Methods PubMed was used to search the following terms, separately and in combination: adverse, condition, cutaneous, dermatosis, dermatitis, injection, PCV13, pneumococcal, pneumonia, prevnar, reaction, skin, site, vaccination, and vaccine. All papers were reviewed, and relevant manuscripts, along with their reference citations, were evaluated. Results Several vaccines—including bacillus Calmette-Guerin, hepatitis B, influenza, leishmaniasis, meningitis, pneumococcal, smallpox, tetanus (alone and in combination with diphtheria, pertussis, polio, Haemophilus influenza type B or plague and yellow fever), and varicella-zoster—have been associated with post-vaccination site reactions. A 70-year-old male developed a lichenoid dermatitis that occurred at the pneumococcal vaccine injection site within 2 weeks after PCV13 vaccination; the erythematous nodule resolved spontaneously within 9 weeks following immunization. Conclusions Dermatoses at the injection sites of vaccines can be granulomatous, immunity-related conditions, infections, lichenoid, neutrophilic, or pseudolymphomatous. Basal cell carcinoma and squamous cell carcinoma are the most common vaccination site-associated malignancies; however, melanoma and sarcomas (dermatofibrosarcoma protuberans, fibrosarcoma, and malignant fibrous histiocytoma) are also smallpox vaccine-related site neoplasms. A cutaneous immunocompromised district that is created by vaccine-induced local immunologic changes is hypothesized to be the pathogenesis of vaccination site reactions.
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Affiliation(s)
- Philip R Cohen
- Department of Dermatology, University of California San Diego, San Diego, CA, USA.
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Kim J, Seo J, Oh SH. Unusual presentation of histiocytoid Sweet's syndrome in a pediatric patient. Int J Dermatol 2015; 54:e555-7. [PMID: 26341715 DOI: 10.1111/ijd.12960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 12/22/2014] [Accepted: 12/31/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Jihee Kim
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jimyung Seo
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Ho Oh
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea.
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Chiang CH, Lin MH. Calcinosis cutis following seasonal influenza vaccination. J Formos Med Assoc 2014; 114:895-6. [PMID: 24751284 DOI: 10.1016/j.jfma.2014.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 03/16/2014] [Accepted: 03/19/2014] [Indexed: 11/26/2022] Open
Affiliation(s)
- Chi-Hsuan Chiang
- Department of Dermatology, Chi Mei Medical Center, Yongkang, Tainan City, Taiwan, ROC
| | - Ming-Hsien Lin
- Department of Dermatology, Chi Mei Medical Center, Yongkang, Tainan City, Taiwan, ROC; Department of Dermatology, Chi Mei Medical Center, Liouying, Tainan City, Taiwan, ROC.
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Pedrosa AF, Morais P, Nogueira A, Pardal J, Azevedo F. Sweet’s syndrome triggered by pneumococcal vaccination. Cutan Ocul Toxicol 2013; 32:260-1. [DOI: 10.3109/15569527.2012.759960] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Tabache F, El Kartouti A, Abdelilah T, El Mejareb C, Hassikou H, El Baaj M. Systemic lupus erythematosus revealed by sweet syndrome. Joint Bone Spine 2011; 78:420-1. [DOI: 10.1016/j.jbspin.2011.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2010] [Indexed: 11/30/2022]
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Pauwels C, Bulai Livideanu C, Maza A, Lamant L, Paul C. Cytophagic Histiocytic Panniculitis after H1N1 Vaccination: A Case Report and Review of the Cutaneous Side Effects of Influenza Vaccines. Dermatology 2011; 222:217-20. [DOI: 10.1159/000326912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 02/18/2011] [Indexed: 01/09/2023] Open
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Syndrome de Sweet après vaccination antigrippale H1N1. Ann Dermatol Venereol 2010; 137:740-1. [DOI: 10.1016/j.annder.2010.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 06/28/2010] [Accepted: 08/25/2010] [Indexed: 11/23/2022]
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Erupciones inflamatorias y purpúricas. DERMATOLOGÍA NEONATAL 2009. [PMCID: PMC7161408 DOI: 10.1016/b978-84-8086-390-2.50019-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Baselga E, Torrelo A. Inflammatory and Purpuric Eruptions. NEONATAL DERMATOLOGY 2008. [PMCID: PMC7315339 DOI: 10.1016/b978-1-4160-3432-2.50022-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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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: 499] [Impact Index Per Article: 29.4] [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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Abstract
OBJECTIVE To systematically review the pertinent literature on drug-induced Sweet's syndrome (SS). DATA SOURCES MEDLINE (1966-December 2006), International Pharmaceutical Abstracts (1970-December 2006), Science Citation Index (1945-December 2006), and EMBASE (1980-December 2006) were searched using the key terms Sweet's syndrome, drug-induced, and acute neutrophilic dermatitis. STUDY SELECTION AND DATA EXTRACTION All case reports of drug-induced SS located using the above databases were collected for causality assessment. In addition, relevant articles regarding the various causes and presentations of SS were selected to provide background information. Bibliographies of all relevant articles were reviewed for additional citations. DATA SYNTHESIS All case reports of drug-induced SS were evaluated against an expanded Naranjo scale with specific criteria for SS. Tables were developed listing key criteria for evaluating the case reports for causality. Data were evaluated by quantity and quality of evidence, and an assessment was made as to whether there was a feasible pharmacologic mechanism to explain causality. CONCLUSIONS Granulocyte colony-stimulating factor (G-CSF), all-trans retinoic acid (ATRA), and vaccines met 2 of 3 criteria for an association with SS. There are sufficient data and a plausible pharmacologic mechanism for G-CSF and ATRA. Vaccines meet the qualitative criteria and also have a plausible pharmacologic mechanism. The evidence regarding minocycline is of high quality; however, the quantity of evidence and a reasonable pharmacologic mechanism are lacking. A host of miscellaneous drugs have also been implicated in causing the disorder, all without sufficient evidence.
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Affiliation(s)
- Dennis F Thompson
- Department of Pharmacy Practice, College of Pharmacy, Southwestern Oklahoma State University, Weatherford, OK 73103, USA.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2005. [DOI: 10.1002/pds.1030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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