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Dias PR, Bolt L, Iking-Konert C, Arrigo M, Huber LC. Multiple Abscess Collections: Antibiotics or Steroids? Case Reports Immunol 2024; 2024:3671685. [PMID: 38304552 PMCID: PMC10834088 DOI: 10.1155/2024/3671685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/27/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024] Open
Abstract
Aseptic abscess syndrome (AAS) is a medical rarity. The combination of multiple abscess collections in different organs, negative microbiological studies, and the association with an inflammatory bowel disease is highly suggestive for an AAS. The AAS is an acute neutrophilic dermatosis, so "generalized pyoderma gangraenosum" or "generalized bullous sweet syndrome" might be used synonymously. It is important to note that the diagnosis of an AAS can be made only after careful exclusion of an infectious disease. Of interest, despite the severity of the inflammation, patients with AAS are commonly hemodynamically stable. To date, no studies have investigated the optimal regimen, dose, and duration of therapy. Corticosteroids are the cornerstone of immunosuppression during the acute phase. After the induction phase, therapy might be switched to anakinra or infliximab.
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Affiliation(s)
| | - Levin Bolt
- Department of Internal Medicine, Stadtspital Zurich Triemli, Zurich, Switzerland
| | | | - Mattia Arrigo
- Department of Internal Medicine, Stadtspital Zurich Triemli, Zurich, Switzerland
| | - Lars C. Huber
- Department of Internal Medicine, Stadtspital Zurich Triemli, Zurich, Switzerland
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Shibuya T, Nomura O, Nomura K, Haraikawa M, Haga K, Ishikawa D, Osada T, Yamaji K, Ikeda S, Nagahara A. Efficacy of cytapheresis for induction therapy and extra-intestinal skin manifestations of ulcerative colitis. Ther Apher Dial 2022; 26:522-528. [PMID: 35247233 DOI: 10.1111/1744-9987.13823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/14/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In recent years, the prevalence of inflammatory bowel diseases has been increasing in Japan due to the westernization of lifestyles. Many patients have been reported to have extra-intestinal manifestations (EIMs) at least once. Skin lesions occur with a high degree of frequency among EIMs, with erythema nodosum (EN) and pyoderma gangrenosum (PG) the main complications. Cytapheresis is again attracting attention as a treatment with few side effects. METHODS We investigated the therapeutic effect of cytapheresis on ulcerative colitis (UC) and cutaneous EIMs. Between 2008 and 2021, 240 patients with active UC had induction therapy by cytapheresis at our hospital. RESULTS Remission and response rates were 50.0% and 67.5%, respectively. Apheresis was performed on 7 patients with PG and 5 patients with EN with a good response. Serious adverse events were not observed. CONCLUSION This retrospective assessment of efficacy showed that EN and PG responded favorably to cytapheresis. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Tomoyoshi Shibuya
- Department of Gastroenterology, Juntendo University school of medicine
| | - Osamu Nomura
- Department of Gastroenterology, Juntendo University school of medicine
| | - Kei Nomura
- Department of Gastroenterology, Juntendo University school of medicine
| | - Mayuko Haraikawa
- Department of Gastroenterology, Juntendo University school of medicine
| | - Keiichi Haga
- Department of Gastroenterology, Juntendo University school of medicine
| | - Dai Ishikawa
- Department of Gastroenterology, Juntendo University school of medicine
| | - Taro Osada
- Department of Gastroenterology Juntendo University Urayasu Hospital
| | - Ken Yamaji
- Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine
| | - Shigaku Ikeda
- Department of Dermatology and Allergology, Juntendo University Graduate School of Medicine
| | - Akihito Nagahara
- Department of Gastroenterology, Juntendo University school of medicine
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Delplanque M, Ducharme-Bénard S, Moguelet P, Chasset F, Grateau G, Georgin-Lavialle S, Bachmeyer C. Is neutrophilic dermatosis a manifestation of familial Mediterranean fever? Scand J Rheumatol 2021; 51:42-49. [PMID: 34159892 DOI: 10.1080/03009742.2021.1904588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives: Familial Mediterranean fever (FMF) is the most frequent monogenic autoinflammatory disease. It is associated with MEFV mutations. Its main features are recurrent episodes of fever and serositis. Patients can display dermatological manifestations such as erysipelas-like erythema, generally considered as a neutrophilic dermatosis (ND). It has been suggested that FMF can be associated with other types of ND. Our aim was to perform a systematic review of the literature to assess the link between ND and FMF.Method: A systematic review of the literature was performed using MEDLINE from 1946 to 2018. Three independent investigators identified reports of non-erysipelas-like erythema neutrophilic dermatosis (NEND) associated with FMF, selected the criteria to establish the diagnosis of FMF and ND, and evaluated the link between the two conditions. FMF-associated NEND was supported by confirmation of both diagnoses and exclusion of other causes of ND.Results: Eighteen articles were selected. Nine articles reported FMF patients with the following NEND: neutrophilic panniculitis (n = 4), Sweet syndrome (n = 6), and pyoderma gangrenosum (n = 1). None of these cases was supported by histological confirmation, fulfilled diagnostic criteria for definitive or probable FMF, or confirmed the exclusion of all the most frequent diseases associated with NEND. As a result, there is insufficient evidence to support a potential relationship between NEND and FMF.Conclusions: The association between FMF and NEND remains unclear. In FMF patients with NEND, every differential diagnosis and alternative cause of NEND should be excluded before drawing any conclusions about a potential causal relationship.
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Affiliation(s)
- M Delplanque
- Internal Medicine Department, Reference Centre for Autoinflammatory Diseases and Amyloidosis (CEREMAIA), Tenon Hospital, Paris, France
| | - S Ducharme-Bénard
- Internal Medicine Department, Sacré-Coeur Hospital, Montreal, Canada
| | - P Moguelet
- Anatomopathology Department, Tenon Hospital, Paris, France
| | - F Chasset
- Dermatology Department, Tenon Hospital, Paris, France
| | - G Grateau
- Internal Medicine Department, Reference Centre for Autoinflammatory Diseases and Amyloidosis (CEREMAIA), Tenon Hospital, Paris, France
| | - S Georgin-Lavialle
- Internal Medicine Department, Reference Centre for Autoinflammatory Diseases and Amyloidosis (CEREMAIA), Tenon Hospital, Paris, France
| | - C Bachmeyer
- Internal Medicine Department, Reference Centre for Autoinflammatory Diseases and Amyloidosis (CEREMAIA), Tenon Hospital, Paris, France
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DERMATOSE NEUTROFÍLICA E POLIARTRITE: UMA ASSOCIAÇÃO DE DOENÇAS OU UMA SÍNDROME DISTINTA? REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2017.07.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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5
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Aounallah A, Zerriaa S, Ksiaa M, Jaziri H, Boussofara L, Ghariani N, Mokni S, Saidi W, Sriha B, Belajouza C, Denguezli M, Nouira R. [Bowel-associated dermatosis-arthritis syndrome during ulcerative colitis: A rare extra-intestinal sign of inflammatory bowel disease]. Ann Dermatol Venereol 2016; 143:377-81. [PMID: 26988382 DOI: 10.1016/j.annder.2016.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 11/20/2015] [Accepted: 02/03/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Bowel-associated dermatosis-arthritis syndrome (BADAS) is characterized by combined pustular skin eruption and arthralgia. It may be associated with inflammatory bowel disease or bowel bypass surgery. We report a case of BADAS in a patient with ulcerative colitis. CASE REPORT A 39-year-old woman was being treated for a severe flare-up of ulcerative colitis present over the preceding 2 months and treated with prednisone, azathioprine and cyclosporine. She was also presenting a cutaneous eruption and arthralgia that had begun three days earlier. Dermatological examination revealed profuse vesicular and pustular lesions. Biopsy specimens showed mature neutrophilic infiltrate within the dermis. A diagnosis of BADAS was made and the same treatment was maintained. Systemic symptoms were resolved but the vesicular lesions were superseded by hypertrophic scars. DISCUSSION Bowel-associated dermatosis-arthritis syndrome consists of a vesiculopustular eruption associated with arthralgia and/or arthritis and fever, as was the case in our patient. The histological picture is characterized by abundant neutrophilic infiltrate in the superficial dermis. The clinical and histological features and the course of BADAS allow this entity to be classified within the spectrum of neutrophilic dermatoses. Treatment chiefly involves systemic corticosteroids.
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Affiliation(s)
- A Aounallah
- Université de Sousse, avenue Khlifa Karoui, 4054 Sousse, Tunisie; Service de dermatologie, CHU Farhat Hached, avenue Ibn El Jazzar, 4000 Sousse, Tunisie.
| | - S Zerriaa
- Université de Sousse, avenue Khlifa Karoui, 4054 Sousse, Tunisie; Service de dermatologie, CHU Farhat Hached, avenue Ibn El Jazzar, 4000 Sousse, Tunisie
| | - M Ksiaa
- Service de gastro-entérologie, hôpital universitaire Sahloul, route Ceinture Cité Sahloul, 4054 Sousse, Tunisie
| | - H Jaziri
- Service de gastro-entérologie, hôpital universitaire Sahloul, route Ceinture Cité Sahloul, 4054 Sousse, Tunisie
| | - L Boussofara
- Université de Sousse, avenue Khlifa Karoui, 4054 Sousse, Tunisie; Service de dermatologie, CHU Farhat Hached, avenue Ibn El Jazzar, 4000 Sousse, Tunisie
| | - N Ghariani
- Université de Sousse, avenue Khlifa Karoui, 4054 Sousse, Tunisie; Service de dermatologie, CHU Farhat Hached, avenue Ibn El Jazzar, 4000 Sousse, Tunisie
| | - S Mokni
- Université de Sousse, avenue Khlifa Karoui, 4054 Sousse, Tunisie; Service de dermatologie, CHU Farhat Hached, avenue Ibn El Jazzar, 4000 Sousse, Tunisie
| | - W Saidi
- Service de dermatologie, CHU Farhat Hached, avenue Ibn El Jazzar, 4000 Sousse, Tunisie
| | - B Sriha
- Laboratoire d'anatomie et de cytologie pathologiques, hôpital Fahat Hached, avenue Ibn El Jazzar, 4000 Sousse, Tunisie
| | - C Belajouza
- Université de Sousse, avenue Khlifa Karoui, 4054 Sousse, Tunisie; Service de dermatologie, CHU Farhat Hached, avenue Ibn El Jazzar, 4000 Sousse, Tunisie
| | - M Denguezli
- Université de Sousse, avenue Khlifa Karoui, 4054 Sousse, Tunisie; Service de dermatologie, CHU Farhat Hached, avenue Ibn El Jazzar, 4000 Sousse, Tunisie
| | - R Nouira
- Université de Sousse, avenue Khlifa Karoui, 4054 Sousse, Tunisie; Service de dermatologie, CHU Farhat Hached, avenue Ibn El Jazzar, 4000 Sousse, Tunisie
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Atteintes extracutanées d’une dermatose neutrophilique. Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.10.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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[Dermatological manifestations of monoclonal gammopathies: contribution of cutaneous histopathology]. Ann Pathol 2015; 35:281-93. [PMID: 26188671 DOI: 10.1016/j.annpat.2015.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 05/06/2015] [Indexed: 12/19/2022]
Abstract
Skin manifestations associated with monoclonal gammapathy are common and can present with various clinical and pathological aspects. They can be the first events leading to the diagnosis of monoclonal gammapathy. They may be present either as specific lesions, including lymphoplasmacytic or pure plasma cell neoplastic infiltrates and monoclonal immunoglobulin deposits, or as non-specific dermatitis, such as leukocytoclastic vasculitis, neutrophilic dermatoses, mucinoses or xanthomatosis, giving little clues for the diagnosis of the underlying disease.
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Daoui L, Hali F, Zouhair K, Zamiati S, Benchikhi H. Pyoderma gangrenosum cutanéomuqueux mimant une cellulite cervicale infectieuse. Ann Dermatol Venereol 2014; 141:249-51. [DOI: 10.1016/j.annder.2013.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 12/05/2013] [Indexed: 10/25/2022]
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Copaescu AM, Castilloux JF, Chababi-Atallah M, Sinave C, Bertrand J. A classic clinical case: neutrophilic eccrine hidradenitis. Case Rep Dermatol 2013; 5:340-6. [PMID: 24474918 PMCID: PMC3901592 DOI: 10.1159/000356229] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Neutrophilic eccrine hidradenitis (NEH) is a rare condition described mostly in adult patients receiving chemotherapy for acute myelogenous leukemia. When it affects the facial region, it can mimic cellulitis and delay the diagnostic, thus proper recognition is essential. OBJECTIVE This article describes a classic case of NEH. We will review the diagnostic, the differential diagnostic (mostly cellulitis) and the management of this condition. METHODS After a literature review, the patient's file was properly studied in order to portray a clear picture of this condition. Medical photographs and appropriate physical examination upon presentation are also included. RESULTS The diagnostic for NEH was suggested by the clinical presentation and confirmed histopathologically (skin biopsy). CONCLUSION The diagnostic of NEH is essential in order to prevent multiple unnecessary antibiotics.
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Affiliation(s)
- Ana-Maria Copaescu
- Division of Dermatology, Department of Medicine, Université de Sherbrooke, Qué., Canada
| | - Jean-François Castilloux
- Division of Hematology and Oncology, Department of Medicine, Université de Sherbrooke, Qué., Canada
| | - Myrna Chababi-Atallah
- Department of Pathology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Qué., Canada
| | - Christian Sinave
- Division of Infectiology, Department of Microbiology and Infectiology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Qué., Canada
| | - Janie Bertrand
- Division of Dermatology, Department of Medicine, Université de Sherbrooke, Qué., Canada
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Caucanas M, Heylen A, Rolland F, Müller G, Olemans C, Sass U, Vanhooteghem O. Associated pyoderma gangrenosum, erythema elevatum diutinum, and Sweet’s syndrome: the concept of neutrophilic disease. Int J Dermatol 2013; 52:1185-8. [DOI: 10.1111/j.1365-4632.2011.05415.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chelly I, Zehani A, Mbazaa A, Azouz H, Nfoussi H, Kchir N, Haouet S, Zitouna M. [Sweet's syndrome: retrospective case series of 47 patients]. Rev Med Interne 2012. [PMID: 23195911 DOI: 10.1016/j.revmed.2012.10.373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Also called acute febrile neutrophilic dermatosis, Sweet's syndrome is an inflammatory disorder with a prominent cutaneous expression. It is characterized by a variety of manifestations, clinical and histological findings. The objective of this study was to describe their clinical, pathological and therapeutic characteristics. METHODS We report on a series of 47 patients who presented a Sweet's syndrome, collected in our institution in Tunis between 1997 and 2011. RESULTS The patient population consisted of 11 men and 36 women. The mean age was 47 years with extreme ranging from 28 to 74 years. An associated disorder was observed in ten patients: inflammatory disease (three cases), inflammatory bowel disease (two cases), tuberculosis (three cases) and diabetes (three cases). One case of pregnancy was observed. Cutaneous lesions consisted of erythematous plaques or nodules. Lesions were located mainly on the upper or lower extremities. All biopsy specimens demonstrated a dermal infiltrate composed predominantly of neutrophils. Fibrinoid necrosis and intramural inflammation were observed in eight cases. CONCLUSION The skin disorder can precede, follow, or appear concurrent with the diagnosis of an associated disease which requires careful surveillance.
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Affiliation(s)
- I Chelly
- Service d'anatomie et de cytologie pathologiques, hôpital La Rabta, Tunis, Tunisie
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13
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Vergier B. [Cutaneous neutrophils infiltrates. Case 6. Neutrophilic dermatosis (Sweet syndrome) with atypical "blast-like" cells]. Ann Pathol 2011; 31:194-7. [PMID: 21737001 DOI: 10.1016/j.annpat.2011.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2011] [Indexed: 10/18/2022]
Affiliation(s)
- Béatrice Vergier
- Service de pathologie, hôpital du Haut-Lévêque, avenue de Magellan, 33604 Pessac cedex, France.
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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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Poiraud C, Gagey-Caron V, Barbarot S, Durant C, Ayari S, Stalder JF. Pyoderma gangrenosum cutanéomuqueux et systémique. Ann Dermatol Venereol 2010; 137:212-5. [DOI: 10.1016/j.annder.2010.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Accepted: 12/18/2009] [Indexed: 02/06/2023]
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Hornez E, Monchal T, Ottomani S, Bourgouin S, Platel JP, Fournier B, Thouard H. Pyoderma gangrenosum sur un orifice de drainage, pris pour un sepsis abdominal après une chirurgie colorectale. ACTA ACUST UNITED AC 2009; 146:576-8. [DOI: 10.1016/j.jchir.2009.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Internal diseases can manifest in a myriad of skin dermatoses ranging from single disorders such as calciphylaxis, cryoglobulinemia, amyopathic dermatomyositis, and Raynaud phenomenon, to spectrum disorders such as the neutrophilic dermatoses and morphea. In this article the underlying causes, triggering events, constitutional symptoms, clinical features and presentations, appearance at various stages, and pathogenesis are described. The course of the diseases and probable healing outcomes are outlined. Finally, examination and diagnostic methods, and therapies and treatments are provided.
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Affiliation(s)
- Andrew G Franks
- Department of Dermatology, New York University School of Medicine, 550 First Avenue, New York, NY 10016, USA.
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Frigui M, Masmoudi A, Kaddour N, Jlidi R, Turki H, Bahloul Z. Dermatose neutrophilique associée à des anticorps anticytoplasme des polynucléaires neutrophiles (ANCA) après prise de benzylthiouracile. Ann Dermatol Venereol 2009; 136:422-6. [DOI: 10.1016/j.annder.2008.09.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Accepted: 09/25/2008] [Indexed: 12/16/2022]
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Gaspar C, Leyral C, Orlandini V, Begueret H, Pellegrin JL, Doutre MS, Beylot-Barry M. [Lethal pulmonary involvement of neutrophilic dermatosis following erythropoietin therapy]. Ann Dermatol Venereol 2008; 135:384-8. [PMID: 18457725 DOI: 10.1016/j.annder.2007.11.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Accepted: 11/09/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Neutrophilic disease is characterized by aseptic visceral infiltration by normal polymorphonuclear leukocytes that can occur in any organ. Association with an underlying systemic disease, particularly haematological malignancy or inflammatory bowel disease, is frequent. This may produce a multisystem disorder, but diagnosis is usually based on skin lesions because of their clinical and histological accessibility. Pulmonary manifestations are the most common extracutaneous symptoms but may be misdiagnosed, as in our case report. CASE REPORT A 77-year-old woman with IgA myeloma presented with an inflammatory bullous plaque of the leg coupled with fever lasting one week. The clinical and histological examinations were evocative of a neutrophilic dermatosis such as Sweet's syndrome. Significant improvement was initially obtained with systemic corticosteroids and colchicine. The course became complicated by necrotic neutrophilic papulopustular lesions of the upper limbs and pulmonary manifestations, with fever and decline in overall condition occurring the day after administration of erythropoietin. A hypothesis of septic aetiology prompted antibiotic and antifungal therapy, which remained ineffective. The patient died the day after the second erythropoietin injection. DISCUSSION This case involved late identification of the aseptic neutrophilic aetiology of pulmonary manifestations. Several factors favouring their appearance and the fatal outcome may be suggested: the existence of a myeloma, association with myelodysplastic syndrome and the possible iatrogenic action of erythropoietin. To the best of our knowledge, this is the first reported case of extracutaneous neutrophilic infiltrate occurring in a patient treated with this haematopoietic hormone.
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Affiliation(s)
- C Gaspar
- Service de dermatologie, hôpital du Haut-Lévêque, CHU de Bordeaux, avenue de Magellan, 33604 Pessac, France
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Bedi MK. Successful treatment of long-standing, recalcitrant subcorneal pustular dermatosis with etanercept. Skinmed 2007; 6:245-7. [PMID: 17786105 DOI: 10.1111/j.1540-9740.2007.888109.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
- Monica K Bedi
- Dermatology Associates of Sarasota, 3830 Bee Ridge Road, Sarasota, FL 34233, USA.
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Bardagí M, Lloret A, Fondati A, Ferrer L. Neutrophilic dermatosis resembling pyoderma gangrenosum in a dog with polyarthritis. J Small Anim Pract 2007; 48:229-32. [PMID: 17381769 DOI: 10.1111/j.1748-5827.2006.00209.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This report describes a case of neutrophilic dermatosis in a dog, with a number of clinical and pathological similarities to human pyoderma gangrenosum. A seven-year-old, female German shepherd dog with a history of non-erosive idiopathic polyarthritis was presented with severe facial swelling, bilateral erosivoulcerative lesions on the muzzle and multiple, eroded, dermal-subcutaneous nodules on the cranial trunk. Histopathological examination of skin biopsies revealed a necrotising neutrophilic dermatitis. No infectious agents could be detected using specific stains, immunohistochemistry, serology and bacterial aerobic, anaerobic or fungal cultures. A sterile neutrophilic dermatosis resembling human pyoderma gangrenosum was presumptively diagnosed, and the patient showed an excellent response to treatment with prednisone and ciclosporin.
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Affiliation(s)
- M Bardagí
- Department of Animal Medicine & Surgery and Veterinary Teaching Hospital, Veterinary School, Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain
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Masmoudi A, Chaaben H, Hamdouni K, Boudaya S, Bouassida S, Turki H, Zahaf A. [Sweet syndrome: retrospective study of 54 cases]. Presse Med 2007; 36:419-24. [PMID: 17321363 DOI: 10.1016/j.lpm.2006.07.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2006] [Accepted: 07/20/2006] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Sweet syndrome is the most common neutrophilic dermatosis. We studied its natural history and epidemiologic, clinical, and therapeutic characteristics from a series of 54 cases. MATERIALS AND METHODS This retrospective study examines 54 cases collected over a 10-year-period. Diagnosis was based on clinical and histological criteria. RESULTS Patients' mean age was 47 years. The sex ratio was 8 women for every man. Disease developed most often in autumn and onset was sudden in all patients. Untypical aspects were found in 20 patients. Lesions were located mainly on the arms (43 cases) and legs (33 cases). No mucous membrane involvement was observed. Histological testing found leukocytoclastic vasculitis in 8 cases. Sweet syndrome was idiopathic for 38 patients. Lesions began at the site of previous trauma for 9 patients, occurred during pregnancy for 2, and were associated with cancer for 3. First-line treatment was colchicine for 23 patients and oral steroids for 12. Six patients had recurrences and 2 patients had relapses. COMMENTARY This large series of patients with Sweet syndrome differs from other reports by the frequency of untypical aspects and post-traumatic forms, as well as the rarity of association with cancer. Histological findings of vasculitis do not rule out a diagnosis of Sweet syndrome.
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Guerre-Schmidt AR, Pelletier F, Carbonnel F, Humbert P, Aubin F. Syndrome arthrocutané associé à une maladie de Crohn chez une adolescente. Rev Med Interne 2006; 27:874-7. [PMID: 16997433 DOI: 10.1016/j.revmed.2006.07.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2006] [Revised: 07/21/2006] [Accepted: 07/21/2006] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Pustulosis, erythema nodosum, arthritis and systemic manifestations are associated in the dermatosis-arthritis syndrome. It is a well recognized complication of the bowel ileo-jejunal bypass but it is also associated with inflammatory bowel diseases. EXEGESE We report the case of an adolescent who presented with a dermatosis-arthritis syndrome associated to a Crohn's disease during a referring for pustulosis, erythema nodosum and fever. The evolution is complicated by proctorragia. Colonoscopy and intestinal biopsy found a Crohn's disease. Cutaneous and intestinal symptoms quickly improved with systemic corticosteroids. CONCLUSION The dermatosis-arthritis syndrome can be associated with bowel bypass and with inflammatory bowel disease, more frequently with ulcerative colitis than with Crohn's disease. It consists in a vesiculo-pustular eruption, erythema nodosum, fever, arthritis and ocular manifestations. Histopathology bears a strong resemblance with Sweet's syndrome. Physiopathology implicates microbial proliferation, formation of immune complex against skin and activation and migration of neutrophils and increasing factors. The treatment is based on corticosteroids and non steroid anti-inflammatory drugs or dapsone.
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Affiliation(s)
- A-R Guerre-Schmidt
- Département de dermatologie, CHU Saint-Jacques, 2, place Saint-Jacques, 25030 Besancon cedex, France
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Belot V, Perrinaud A, Corven C, de Muret A, Lorette G, Machet L. Hidradénite eccrine neutrophilique idiopathique de l’adulte d’évolution prolongée traitée par colchicine. Presse Med 2006; 35:1475-8. [PMID: 17028536 DOI: 10.1016/s0755-4982(06)74837-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Neutrophilic eccrine hidradenitis (NEH) is a rare disease belonging to the group of neutrophilic dermatoses. It has a characteristic histopathologic pattern, with necrosis of the eccrine glands and a local neutrophilic infiltrate. It occurs mostly in patients receiving chemotherapy for acute myeloblastic leukemia or, less frequently, another malignancy. Its occurrence in healthy patients is rare. CASE REPORT We report the case of a 56-year-old woman with no remarkable medical history who developed an erythematous papular facial eruption. Skin biopsy showed typical features of neutrophilic eccrine hidradenitis including neutrophilic infiltrate. No cause was found. The patient was successfully treated with colchicine. DISCUSSION This case is particular because NEH was not associated with malignant hematologic disease, solid cancer, chemotherapy, fever or any other disease, after a follow-up of 22 months. Such idiopathic NEH has been reported only rarely in adults. The second particularity is the length of the eruption, which required colchicine treatment. Clinical improvement occurred within 1 month. Because hematologic malignancies can in some cases be preceded by neutrophilic dermatitis, clinical follow-up is recommended in adults.
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Affiliation(s)
- Véronique Belot
- Service de dermatologie, centre hospitalier Universitaire, Tours (37)
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Puget M, Cathébras P, Rousset H, Paccalin M. [Pregnancy complications and baby blues...]. Rev Med Interne 2005; 26 Suppl 2:S226-9. [PMID: 16129153 DOI: 10.1016/s0248-8663(05)80033-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- M Puget
- Service de médecine interne, pavillon Giraud 1K, hôpital Lyon-Sud, Pierre-Bénite, France
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André M, Piette JC, Francès C, Aumaître O. Dermatoses neutrophiliques et abcès aseptiques : deux expressions cliniques d’une même entité. Rev Med Interne 2005; 26:5-7. [PMID: 15639319 DOI: 10.1016/j.revmed.2004.10.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2004] [Accepted: 10/21/2004] [Indexed: 10/26/2022]
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