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Alzahrani F, Tolson H, Dupuy E, Price H. Paediatric Sweet's syndrome with pulmonary involvement triggered by severe inflammatory bowel disease and emergent total abdominal colectomy with literature review. SKIN HEALTH AND DISEASE 2024; 4:e326. [PMID: 38577048 PMCID: PMC10988687 DOI: 10.1002/ski2.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/15/2023] [Accepted: 12/06/2023] [Indexed: 04/06/2024]
Abstract
Sweet's syndrome (SS) is a neutrophilic dermatosis characterised by the acute onset of erythematous papules or plaques and a constellation of symptoms including fever, leucocytosis, and histopathology demonstrating nodular, pustular, or diffuse infiltrate of neutrophils with marked papillary oedema. SS can be a manifestation of inflammatory bowel disease and often coincides with periods of disease flares. Only a few cases of SS associated with ulcerative colitis are reported in the literature, and no cases have involved pulmonary manifestations in the paediatric population. We present a case of a 14-year-old girl presenting with new onset ulcerative colitis requiring emergent colectomy with subsequent development of pulmonary SS. Treatment consisted of intravenous and oral corticosteroids and dapsone. SS should be considered in the differential diagnosis of prolonged fever with cutaneous involvement and systemic symptoms. Special consideration should be given to paediatric patients with extracutaneous manifestations, particularly pulmonary involvement.
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Affiliation(s)
- Fatmah Alzahrani
- Division of DermatologyPhoenix Children's HospitalPhoenixArizonaUSA
- Mayo Clinic College of Medicine and SciencePhoenixArizonaUSA
| | - Hannah Tolson
- Department of Child HealthUniversity of Arizona College of MedicinePhoenixArizonaUSA
| | - Elizabeth Dupuy
- Division of DermatologyPhoenix Children's HospitalPhoenixArizonaUSA
- Mayo Clinic College of Medicine and SciencePhoenixArizonaUSA
| | - Harper Price
- Division of DermatologyPhoenix Children's HospitalPhoenixArizonaUSA
- Mayo Clinic College of Medicine and SciencePhoenixArizonaUSA
- Department of Child HealthUniversity of Arizona College of MedicinePhoenixArizonaUSA
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Michl C, Hühn R, Sunderkötter C. [Sweet syndrome of childhood with acquired cutis laxa (Marshall syndrome) as primary manifestation of Takayasu arteritis]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2022; 73:884-890. [PMID: 35925217 PMCID: PMC9592653 DOI: 10.1007/s00105-022-04999-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 06/15/2023]
Abstract
A special form of the rare infantile Sweet syndrome (acute febrile neutrophilic dermatosis) is facultative healing in the form of postinflammatory elastolysis with acquired cutis laxa, named "Marshall" syndrome after the authors who first described it. We report the case of a 3-year-old child in whom the cutaneous manifestation led to diagnosis of Takayasu arteritis. Postinflammatory elastolysis with acquired cutis laxa is a clinically relevant cutaneous indicator of life-threatening cardiovascular complications such as aortitis, aortic aneurysm, coronary stenosis and heart failure in children with Sweet's syndrome. Cutis laxa usually precedes cardiac complications or, as in our case, occurs simultaneously; thus, immediate cardiac and rheumatologic examinations are important to initiate systemic therapy with anti-inflammatory and immunomodulatory agents early to prevent complications.
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Affiliation(s)
- Christiane Michl
- Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinikum Halle/Saale, Halle/Saale, Deutschland.
- Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Ernst-Grube-Str. 40, 06120, Halle, Deutschland.
| | - Regina Hühn
- Universitätsklinik und Poliklinik für Pädiatrie I, Universitätsklinikum Halle/Saale, Halle/Saale, Deutschland
| | - Cord Sunderkötter
- Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinikum Halle/Saale, Halle/Saale, Deutschland
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Keskinyan VS, Noyd DH, Underwood CM, Van Mater D. Sweet Syndrome in Pediatric Acute Myeloid Leukemia. J Pediatr Hematol Oncol 2021; 43:31-32. [PMID: 32925399 PMCID: PMC7736186 DOI: 10.1097/mph.0000000000001900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | - David H. Noyd
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Duke University Medical Center
| | | | - David Van Mater
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Duke University Medical Center
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Knöpfel N, Theiler M, Luchsinger I, Hafner B, Brunner C, Kolm I, Weibel L. Infliximab for the treatment of recalcitrant bullous Sweet syndrome in a 10-year-old girl. Pediatr Dermatol 2020; 37:1183-1184. [PMID: 32901971 DOI: 10.1111/pde.14356] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We report the case of a 10-year-old girl with bullous Sweet syndrome, recalcitrant to high-dose systemic corticosteroids. Subsequent treatment with infliximab resulted in a rapid improvement in cutaneous lesions and systemic symptoms. Cutis laxa was noted in the healed skin. We propose early second-line treatment with infliximab in children with steroid-refractory Sweet syndrome.
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Affiliation(s)
- Nicole Knöpfel
- Pediatric Skin Center, Department of Dermatology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Martin Theiler
- Pediatric Skin Center, Department of Dermatology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Isabelle Luchsinger
- Pediatric Skin Center, Department of Dermatology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Bettina Hafner
- Pediatric Skin Center, Skin- and Wound Management, University Children's Hospital Zurich, Zurich, Switzerland
| | - Corinne Brunner
- Pediatric Skin Center, Skin- and Wound Management, University Children's Hospital Zurich, Zurich, Switzerland
| | - Isabel Kolm
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Lisa Weibel
- Pediatric Skin Center, Department of Dermatology, University Children's Hospital Zurich, Zurich, Switzerland
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Jagati A, Shrivastava S, Baghela B, Agarwal P, Saikia S. Acquired cutis laxa secondary to Sweet syndrome in a child (Marshall syndrome): A rare case report. J Cutan Pathol 2019; 47:146-149. [PMID: 31437319 DOI: 10.1111/cup.13567] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 11/29/2022]
Abstract
Sweet syndrome is rare in the pediatric population and usually responds well to treatment, resolving without sequelae. Marshall syndrome is a rare pediatric skin disease characterized by loss of elastic tissue (cutis laxa) secondary to acquired, localized neutrophilic dermatitis without any internal organ involvement. Only few cases of Marshall syndrome (acquired cutis laxa type II) have been reported. Systemic steroids and dapsone show excellent results in Sweet syndrome. Although there is no satisfactory treatment for cutis laxa, dapsone can be used in the acute phase for control of swelling.
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Affiliation(s)
- Ashish Jagati
- Department of Dermatology, N.H.L. Medical College, Ahmedabad, Gujarat, India
| | - Shivank Shrivastava
- Department of Dermatology, Index Medical College, Indore, Madhya Pradesh, India
| | - Bhavna Baghela
- Practicing Dermatologist, Independent Researcher, Ujjain, Madhya Pradesh, India
| | - Pooja Agarwal
- Department of Dermatology, N.H.L. Medical College, Ahmedabad, Gujarat, India
| | - Siddhartha Saikia
- Department of Dermatology, N.H.L. Medical College, Ahmedabad, Gujarat, India
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Buchbinder D, Montealegre Sanchez GA, Goldbach-Mansky R, Brunner H, Shulman AI. Rash, Fever, and Pulmonary Hypertension in a 6-Year-Old Female. Arthritis Care Res (Hoboken) 2018; 70:785-790. [PMID: 29316368 DOI: 10.1002/acr.23506] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 01/02/2018] [Indexed: 01/15/2023]
Affiliation(s)
| | - Gina A Montealegre Sanchez
- NIH Translational Autoinflammatory Disease Studies/ National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Raphaela Goldbach-Mansky
- NIH Translational Autoinflammatory Disease Studies/ National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
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Tangtatco JAA, Ho N, Drucker A, Forse C. Potassium iodide in refractory, recurrent pediatric Sweet syndrome: Guidance in dosing and monitoring. Pediatr Dermatol 2018; 35:271-273. [PMID: 29314271 DOI: 10.1111/pde.13391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We describe a 5-month-old boy with clinical and histopathologic presentation of Sweet syndrome. He responded to systemic corticosteroids, with multiple flares on tapering; potassium iodide was added, which provided complete resolution of Sweet syndrome. Potassium iodide has been used in only a few cases, and no standard dosage has been established in children. We discuss calculation of a pediatric dosage for potassium iodide in Sweet syndrome.
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Affiliation(s)
| | - Nhung Ho
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Aaron Drucker
- Department of Dermatology, Brown University, Providence, Rhode Island
| | - Catherine Forse
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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Takano Y, Fujino H, Yachie A, Sumimoto SI. Serum cytokine profile in pediatric Sweet's syndrome: a case report. J Med Case Rep 2017; 11:178. [PMID: 28668093 PMCID: PMC5494139 DOI: 10.1186/s13256-017-1317-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 05/10/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Sweet's syndrome is characterized by fever, leukocytosis, and tender erythematous papules or nodules. It is a rare condition, particularly in the pediatric population, and has recently been proposed to be an autoinflammatory disease that occurs due to innate immune system dysfunction, involving several cytokines, which causes abnormally increased inflammation. To the best of our knowledge, no report has documented the cytokine profile in a pediatric patient with Sweet's syndrome. CASE PRESENTATION A previously healthy 34-month-old Japanese girl was hospitalized because of remittent fever and pain in her right lower extremity with erythematous nodules. A skin biopsy of the eruption revealed dermal perivascular neutrophilic infiltration with no evidence of vasculitis, which led to the diagnosis of Sweet's syndrome. She was prescribed with orally administered prednisolone and a prompt response was observed; then, the prednisolone dose was tapered. During treatment she developed upper and lower urinary tract infections, after which her cutaneous symptoms failed to improve despite increasing the prednisolone dosage. To avoid long-term use of systemic corticosteroids, orally administered potassium iodide was initiated, but it was unsuccessful. However, orally administered colchicine along with prednisolone effectively ameliorated her symptoms, and prednisolone dosage was reduced again. We analyzed the circulating levels of interleukin-1β, interleukin-6, interleukin-18, neopterin, and soluble tumor necrosis factor receptors I and II, in order to clarify the pathogenesis of Sweet's syndrome. Of these cytokines, only interleukin-6 levels were elevated prior to orally administered prednisolone therapy. Following therapy, the elevated interleukin-6 levels gradually diminished to almost normal levels; interleukin-1β and interleukin-18 stayed within normal ranges throughout the treatment. Neopterin became marginally elevated after the start of treatment. Both soluble tumor necrosis factor receptor I and soluble tumor necrosis factor receptor II levels increased shortly after the onset of urinary tract infections. CONCLUSIONS This is the first case report of pediatric Sweet's syndrome in which serum cytokine levels were investigated. Future studies should gather more evidence to elucidate the pathophysiology of Sweet's syndrome.
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Affiliation(s)
- Yoshihiko Takano
- Department of Pediatrics, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan.
| | - Hisanori Fujino
- Department of Pediatrics, Osaka Red Cross Hospital, 5-30 Fudegasaki-Cho, Tennouji-Ku, Osaka, 543-8555, Japan
| | - Akihiro Yachie
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical, and Health Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Shin-Ichi Sumimoto
- Department of Pediatrics, Osaka Red Cross Hospital, 5-30 Fudegasaki-Cho, Tennouji-Ku, Osaka, 543-8555, Japan
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Aoki T, Yamashita Y, Minamitani K, Ota S, Hayakawa K. Erythematous Plaques in a Child with Sweet Syndrome. J Pediatr 2016; 176:210-210.e1. [PMID: 27318383 DOI: 10.1016/j.jpeds.2016.05.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 05/17/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Takahiro Aoki
- Department of Pediatrics, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Yoshiharu Yamashita
- Department of Pediatrics, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Kanshi Minamitani
- Department of Pediatrics, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Setsuo Ota
- Department of Pediatrics, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Kazuhito Hayakawa
- Department of Dermatology, Teikyo University Chiba Medical Center, Chiba, Japan
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Shinozuka J, Tomiyama H, Tanaka SI, Tahara J, Awaguni H, Makino S, Maruyama R, Imashuku S. Neonatal Sweet's Syndrome Associated with Rectovestibular Fistula with Normal Anus. Pediatr Rep 2015; 7:5858. [PMID: 26266031 PMCID: PMC4508622 DOI: 10.4081/pr.2015.5858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 05/25/2015] [Accepted: 05/25/2015] [Indexed: 11/23/2022] Open
Abstract
Sweet's syndrome, characterized by fever and a painful erythematous rash with a dermal neutrophilic infiltrate, develops primarily due to paraneoplastic phenomena in adults. Sweet's syndrome is very rare in neonates. We report a Japanese female neonate (age <2 months), who developed Sweet's syndrome with episodes of perineal infection in association with congenital rectovestibular fistula with normal anus. Sweet's syndrome was diagnosed basing on clinical features and histopathology of biopsied skin tissues. Rectovestibular fistula was confirmed after the signs of inflammation subsided and the rash disappeared. In the literature, we found another case of neonatal Sweet's syndrome associated with rectovestibular fistula in a Japanese female neonate. The perineal region should be screened for anomalies following diagnosis of Sweet's syndrome in neonates.
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Affiliation(s)
- Jun Shinozuka
- Division of Pediatrics, Uji-Tokushukai Medical Center , Uji, Kyoto, Japan
| | - Hideki Tomiyama
- Division of Pediatric Surgery, Uji-Tokushukai Medical Center , Uji, Kyoto, Japan
| | - Shin-Ichiro Tanaka
- Division of Pediatrics, Uji-Tokushukai Medical Center , Uji, Kyoto, Japan
| | - Junko Tahara
- Division of Pediatrics, Uji-Tokushukai Medical Center , Uji, Kyoto, Japan
| | - Hitoshi Awaguni
- Division of Pediatrics, Uji-Tokushukai Medical Center , Uji, Kyoto, Japan
| | - Shigeru Makino
- Division of Pediatrics, Uji-Tokushukai Medical Center , Uji, Kyoto, Japan
| | - Rikken Maruyama
- Division of Pediatrics, Uji-Tokushukai Medical Center , Uji, Kyoto, Japan
| | - Shinsaku Imashuku
- Division of Laboratory Medicine, Uji-Tokushukai Medical Center , Uji, Kyoto, Japan
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