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Sweet Syndrome Associated with Myelodysplastic Syndrome—A Review of a Multidisciplinary Approach. Life (Basel) 2023; 13:life13030809. [PMID: 36983964 PMCID: PMC10053503 DOI: 10.3390/life13030809] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/03/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
Sweet syndrome (SS) is a rare disease described as a febrile neutrophilic dermatosis with acute onset, the pathogenesis of which has not yet been elucidated. The syndrome is characterized by the sudden onset of erythematous infiltrated papules or plaques located on the upper body and is associated with fever, leukocytosis and neutrophilia. The lesions show a dense dermal infiltration with mature neutrophils. The condition is responsive to systemic steroids. The central nervous system, bones, muscles, eyes, ears, mouth, heart, lung, liver, kidneys, intestines, and spleen may be affected by SS as extracutaneous manifestations. More and more cases have been found to be associated with malignancies, particularly myelodysplastic syndrome, and, less frequently, other hematologic malignancies or solid tumors. Approximately 21% of patients with SS have an associated malignancy and up to 80% of MASS cases are associated with hematological diseases, predominantly myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML). Myelodysplastic syndrome is a clonal disease of the bone marrow characterized by inefficient hematopoiesis, dysplasia of the bone marrow and peripheral cytopenias. Affected patients have a high risk of leukemic transformation. After analyzing later studies and current practical aspects regarding MDS-related SS, we suggest an algorithm for evaluating these patients.
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Bae KN, Shin K, Kim HS, Ko HC, Kim BS, Kim MB. Giant Cellulitis-like Sweet Syndrome Following Varicose Vein Surgery: A Rare Variant of Sweet Syndrome Mimicking Cellulitis. Ann Dermatol 2023; 35:151-154. [PMID: 37041710 PMCID: PMC10112369 DOI: 10.5021/ad.20.129] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 03/22/2021] [Accepted: 03/30/2021] [Indexed: 03/18/2023] Open
Abstract
Giant cellulitis-like Sweet syndrome (GCS) is the most recently defined variant of Sweet syndrome (SS) which could clinically mimic wide-spreading cellulitis. Although there has been only paucity of reports in the literature, it mostly appears at lower half of the body and histologically shows dense infiltration of neutrophils with occasional histiocytoid mononuclear cells. Although its exact etiology has not been clarified, abnormal conditions (e.g., infection, malignancy and drugs) could be related triggering factors and trauma itself can be one of the causative elements as a 'pathergy phenomenon'. GCS could be confusing manifestation especially when appeared in postoperative condition. A 69-year-old female presented with an erythematous edematous papules and plaques on the right thigh after varicose vein surgery. Skin biopsy revealed diffuse neutrophilic infiltrates that was consistent with SS. To our knowledge, there has been no report of GCS as a postoperative complication after varicose vein surgery. Physicians should be aware of this uncommon reactive neutrophilic dermatoses mimicking infectious cutaneous disease.
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Affiliation(s)
- Kyung-Nam Bae
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Kihyuk Shin
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
| | - Hoon-Soo Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hyun-Chang Ko
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
| | - Byung-Soo Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Moon-Bum Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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Joshi TP, Friske SK, Hsiou DA, Duvic M. New Practical Aspects of Sweet Syndrome. Am J Clin Dermatol 2022; 23:301-318. [PMID: 35157247 PMCID: PMC8853033 DOI: 10.1007/s40257-022-00673-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2022] [Indexed: 12/12/2022]
Abstract
Sweet syndrome (SS), or acute febrile neutrophilic dermatosis, is an inflammatory, non-infectious skin reaction characterized clinically by tender, erythematous papules/plaques/pustules/nodules commonly appearing on the upper limbs, trunk, and head and neck; histologically, SS is characterized by dense neutrophilic infiltrate in the dermis. SS is accompanied by fever; an elevation of inflammatory markers (e.g., erythrocyte sedimentation rate, C reactive protein) in serum may also be observed. Although most cases of SS are idiopathic, SS also occurs in the setting of malignancy or following administration of an associated drug. SS has also been reported in association with pregnancy and a burgeoning list of infectious (most commonly upper respiratory tract infections) and inflammatory diseases; likewise, the litany of possible iatrogenic triggers has also grown. Over the past several years, a wider spectrum of SS presentation has been realized, with several reports highlighting novel clinical and histological variants. Corticosteroids continue to be efficacious first-line therapy for the majority of patients with SS, although novel steroid-sparing agents have been recently added to the therapeutic armamentarium against refractory SS. New mechanisms of SS induction have also been recognized, although the precise etiology of SS still remains elusive. Here, we catalogue the various clinical and histological presentations of SS, summarize recently reported disease associations and iatrogenic triggers, and review treatment options. We also attempt to frame the findings of this review in the context of established and emerging paradigms of SS pathogenesis.
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Sweet syndrome with osseous and splenic involvement: A case report. Radiol Case Rep 2021; 17:194-200. [PMID: 34815826 PMCID: PMC8593262 DOI: 10.1016/j.radcr.2021.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/10/2021] [Accepted: 10/11/2021] [Indexed: 01/24/2023] Open
Abstract
Sweet syndrome is an uncommon inflammatory skin condition. Here we present a case of Sweet syndrome in a young woman with rare extracutaneous manifestations, including bone and splenic fluid collections, with marked improvement following treatment with systemic corticosteroids. The patient was subsequently diagnosed with Crohn's disease which can be seen in the setting of Sweet syndrome. Sterile abscesses should be considered in patients with a clinical diagnosis of Sweet syndrome and focal symptomatology.
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Key Words
- AFB, acid fast bacilli
- ANA, antinuclear antibodies
- Abscess
- Acute febrile neutrophilic dermatosis
- CRMO, chronic recurrent multifocal osteomyelitis
- CRP, c-reactive protein
- Crohn's disease
- EKG, electrocardiogram
- ESR, erythrocyte sedimentation rate
- GI, gastrointestinal
- H&E, hematoxylin and eosin
- Osteomyelitis
- PICC, peripherally inserted central catheter
- RF, rheumatoid factor
- SS, Sweet syndrome
- Sweet syndrome
- WBC, white blood cell
- p-ANCA, perinuclear-antineutrophil cytoplasmic antibodies
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Sleiman J, Hitawala AA, Cohen B, Falloon K, Simonson M, Click B, Khanna U, Fernandez AP, Rieder F. Systematic Review: Sweet Syndrome Associated with Inflammatory Bowel Disease. J Crohns Colitis 2021; 15:1864-1876. [PMID: 33891004 PMCID: PMC8675328 DOI: 10.1093/ecco-jcc/jjab079] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND AIMS Sweet syndrome [SS] is a dermatological condition associated with both inflammatory bowel disease [IBD] and azathioprine use. We performed a systematic review to better delineate clinical characteristics and outcomes of SS in IBD patients. METHODS Peer-reviewed, full-text journal publications from inception to April 2020 in English language and adult subjects with IBD were included. Skin biopsy was required as SS gold-standard diagnosis. Azathioprine-associated SS required recent azathioprine introduction or recurrence of SS after azathioprine re-challenge. RESULTS We included 89 publications with 95 patients [mean age of SS diagnosis: 44 years; 59% female; 20 with azathioprine-associated SS and 75 without]. SS was diagnosed prior to IBD in 5.3%, at time of IBD diagnosis in 29.5% and after diagnosis in 64.2%. In total, 91% of patients with SS had known colonic involvement and the majority [76%] had active IBD at diagnosis; 22% had additional extra-intestinal manifestations. Successful therapies for SS included corticosteroids [90.5%], anti-tumour necrosis factor [TNF]-α inhibitor therapy [14.8%] and azathioprine [11.6%]. Azathioprine-associated SS was distinct, with 85% male patients, mean age of SS diagnosis of 50 years and a lower likelihood to be prescribed corticosteroids for treatment [75% vs 94.7% of non-azathioprine-associated SS, p = 0.008]. All patients with azathioprine-associated SS improved with medication cessation and developed recurrence after re-challenge. CONCLUSIONS SS may precede or occur with IBD diagnosis in almost one-third of cases. Azathioprine and IBD-associated SS present and behave distinctly, especially with regard to gender, age at diagnosis and recurrence risk. Corticosteroids and TNF-α inhibitors have demonstrated efficacy in treating SS in IBD.
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Affiliation(s)
- Joseph Sleiman
- Department of Internal Medicine, Cleveland
Clinic, Cleveland, OH, USA
| | - Asif A Hitawala
- Department of Internal Medicine, Cleveland
Clinic, Cleveland, OH, USA
| | - Benjamin Cohen
- Department of Gastroenterology, Hepatology and Nutrition,
Digestive Diseases and Surgery Institute, Cleveland Clinic,
Cleveland, OH, USA
| | - Katie Falloon
- Department of Gastroenterology, Hepatology and Nutrition,
Digestive Diseases and Surgery Institute, Cleveland Clinic,
Cleveland, OH, USA
| | - Marian Simonson
- Floyd D. Loop Alumni Library, Cleveland
Clinic, Cleveland, OH, USA
| | - Benjamin Click
- Department of Gastroenterology, Hepatology and Nutrition,
Digestive Diseases and Surgery Institute, Cleveland Clinic,
Cleveland, OH, USA
| | - Urmi Khanna
- Department of Dermatology, Albert Einstein College of
Medicine/Montefiore Medical Center, Bronx,
NY, USA
| | - Anthony P Fernandez
- Departments of Dermatology and Pathology, Cleveland
Clinic, Cleveland, OH, USA
| | - Florian Rieder
- Department of Gastroenterology, Hepatology and Nutrition,
Digestive Diseases and Surgery Institute, Cleveland Clinic,
Cleveland, OH, USA
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Lim JH, Sim WY, Lew BL. Sweet's Syndrome Limited on the Palms and Soles: A Case Report. Ann Dermatol 2021; 33:459-462. [PMID: 34616128 PMCID: PMC8460475 DOI: 10.5021/ad.2021.33.5.459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/25/2020] [Accepted: 05/19/2020] [Indexed: 12/04/2022] Open
Abstract
Sweet's syndrome was first described as a reactive dermatosis characterized by sudden onset of fever, leukocytosis, and erythematous plaques infiltrated with neutrophils. Therefore, Sweet's syndrome is also known as acute febrile neutrophilic dermatosis. However, subsequently, it became clear that fever and neutrophilia in Sweet's syndrome vary depending on the case, and several other characteristics have been described. The lesions in Sweet's syndrome are typically observed not only in the limbs but also in the face, neck, and upper trunk. A 28-year-old female without a specific medical history presented in a hospital following the complaint of painful erythematous patches and pustules on her palms and soles. She had no previous history of palmoplantar pustulosis and other infections or malignancies. A skin biopsy showed diffuse dermal infiltration of neutrophils. Laboratory tests showed increased neutrophil count and erythrocyte sedimentation rate. After systemic corticosteroid administration was initiated, the lesions gradually disappeared. The patient was subsequently diagnosed with Sweet's syndrome according to histology, clinical feature, and response to treatment. However, there have been few reports of Sweet's syndrome confined to the individuals' palms and soles. According to the literatures, although the dorsum of the hand is frequently affected, the palmoplantar involvement as in our case appears to be rare.
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Affiliation(s)
- Ji-Hoon Lim
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea
| | - Woo-Young Sim
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea
| | - Bark-Lynn Lew
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea
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[Drug-induced Sweet's syndrome related to hydroxychloroquine: About 2 cases]. Rev Med Interne 2019; 41:289-292. [PMID: 31540835 DOI: 10.1016/j.revmed.2019.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 08/22/2019] [Accepted: 08/26/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Hydroxychloroquine is widely prescribed in systemic lupus erythematosus. Dermatologic adverse drug reactions are rare but can mimic a disease specific manifestation of lupus. Exceptionally, Sweet's syndrome, or acute febrile neutrophilic dermatosis, may be drug-induced. CASE REPORTS Two patients aged 31 and 42 years were treated with hydroxychloroquine for systemic lupus and Sjogren's syndrome, respectively. Three weeks after starting treatment, they had a febrile, purple and erythematous papular rash of the trunk and limbs. There was a biological inflammatory syndrome and skin biopsy disclosed an infiltrate of the dermis rich in neutrophils. Lesions regressed after stopping hydroxychloroquine and introducing systemic corticosteroid therapy. Allergologic tests discussed the differential diagnosis with a delayed-type hypersensitivity reaction. CONCLUSION We report two exceptional cases of drug-induced Sweet's syndrome related to hydroxychloroquine treatment in autoimmune rheumatic diseases.
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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: 68] [Impact Index Per Article: 13.6] [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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Marzano AV, Borghi A, Wallach D, Cugno M. A Comprehensive Review of Neutrophilic Diseases. Clin Rev Allergy Immunol 2017; 54:114-130. [DOI: 10.1007/s12016-017-8621-8] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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10
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Bou-Dargham MJ, Khamis ZI, Cognetta AB, Sang QXA. The Role of Interleukin-1 in Inflammatory and Malignant Human Skin Diseases and the Rationale for Targeting Interleukin-1 Alpha. Med Res Rev 2016; 37:180-216. [PMID: 27604144 DOI: 10.1002/med.21406] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 07/19/2016] [Accepted: 07/23/2016] [Indexed: 12/11/2022]
Abstract
Inflammation plays a major role in the induction and progression of several skin diseases. Overexpression of the major epidermal proinflammatory cytokines interleukin (IL) 1 alpha (IL-1α) and 1 beta (IL-1β) is positively correlated with symptom exacerbation and disease progression in psoriasis, atopic dermatitis, neutrophilic dermatoses, skin phototoxicity, and skin cancer. IL-1β and the interleukin-1 receptor I (IL-1RI) have been used as a therapeutic target for some autoinflammatory skin diseases; yet, their system-wide effects limit their clinical usage. Based on the local effects of extracellular IL-1α and its precursor, pro-IL-1α, we hypothesize that this isoform is a promising drug target for the treatment and prevention of many skin diseases. This review provides an overview on IL-1α and IL-β functions, and their contribution to inflammatory and malignant skin diseases. We also discuss the current treatment regimens, and ongoing clinical trials, demonstrating the potential of targeting IL-1α, and not IL-1β, as a more effective strategy to prevent or treat the onset and progression of various skin diseases.
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Affiliation(s)
- Mayassa J Bou-Dargham
- Department of Chemistry and Biochemistry, Florida State University, Tallahassee, FL, 32306.,Institute of Molecular Biophysics, Florida State University, Tallahassee, FL, 32306
| | - Zahraa I Khamis
- Department of Chemistry and Biochemistry, Florida State University, Tallahassee, FL, 32306.,Institute of Molecular Biophysics, Florida State University, Tallahassee, FL, 32306.,Department of Chemistry and Biochemistry, Lebanese University, Faculty of Sciences, Hadath-Beirut, Lebanon
| | - Armand B Cognetta
- Dermatology Associates of Tallahassee and Division of Dermatology, Florida State University College of Medicine, Tallahassee, FL, 32308
| | - Qing-Xiang Amy Sang
- Department of Chemistry and Biochemistry, Florida State University, Tallahassee, FL, 32306.,Institute of Molecular Biophysics, Florida State University, Tallahassee, FL, 32306
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Sweet syndrome secondary to inflammatory bowel disease. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2015; 27:124-5. [PMID: 23516674 DOI: 10.1155/2013/848316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Daloul R, Gupta S, Marin M. Nodular kidney involvement in a patient with idiopathic Sweet's syndrome. BMJ Case Rep 2013; 2013:bcr-2013-010075. [PMID: 24336578 DOI: 10.1136/bcr-2013-010075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 40-year-old previously healthy woman presented with a history of painful maculopapular rash, fever and diffuse arthralgia. The skin biopsy was consistent with Sweet's syndrome. Further workup with abdominal CT revealed bilateral hypoenhancing renal lesions involving the cortex and medulla, as well as terminal ileal thickening. Her renal function was preserved. The urinalysis revealed microscopic haematuria and sterile pyuria. Upper and lower gastrointestinal endoscopies were unremarkable and terminal ileal biopsy was normal. The evaluation for secondary causes of Sweet's syndrome was negative. She responded to corticosteroid therapy. A repeat abdominal CT scan two months later showed complete resolution of renal and ileal lesions. One year after the initial presentation the patient is doing well with no recurrent symptoms. We concluded that the abnormal renal findings were most likely due to sterile abscesses in the course of idiopathic Sweet's syndrome.
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Affiliation(s)
- Reem Daloul
- Department of Internal Medicine, William Beaumont Hospital, Royal Oak, Michigan, USA
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Prat L, Bouaziz JD, Wallach D, Vignon-Pennamen MD, Bagot M. Neutrophilic dermatoses as systemic diseases. Clin Dermatol 2013; 32:376-88. [PMID: 24767185 DOI: 10.1016/j.clindermatol.2013.11.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Neutrophilic dermatoses (ND) are inflammatory skin conditions characterized by a sterile infiltrate of normal polymorphonuclear leukocytes. The main clinical forms of ND include Sweet syndrome, pyoderma gangrenosum, erythema elevatum diutinum, subcorneal pustular dermatosis, and their atypical or transitional forms. ND are often idiopathic, but they may be associated with myeloid hematologic malignancies (Sweet syndrome), inflammatory bowel disease or rheumatoid arthritis (pyoderma gangrenosum), and monoclonal gammopathies (erythema elevatum diutinum, subcorneal pustular dermatosis). The possible infiltration of internal organs with neutrophils during the setting of ND underlies the concept of a neutrophilic systemic disease. ND may be seen as a polygenic autoinflammatory syndrome due to their frequent association with other autoinflammatory disorders (monogenic or polygenic) and the recent published efficacy of interleukin-1 blocking therapies in their management.
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Affiliation(s)
- Lola Prat
- Université Paris Diderot, Sorbonne Paris Cité; AP-HP, Paris, France; Service de Dermatologie et Service d'Anatomo-Pathologie, Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - Jean-David Bouaziz
- Université Paris Diderot, Sorbonne Paris Cité; AP-HP, Paris, France; Service de Dermatologie et Service d'Anatomo-Pathologie, Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France.
| | - Daniel Wallach
- Université Paris Diderot, Sorbonne Paris Cité; AP-HP, Paris, France; Service de Dermatologie et Service d'Anatomo-Pathologie, Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - Marie-Dominique Vignon-Pennamen
- Université Paris Diderot, Sorbonne Paris Cité; AP-HP, Paris, France; Service de Dermatologie et Service d'Anatomo-Pathologie, Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - Martine Bagot
- Université Paris Diderot, Sorbonne Paris Cité; AP-HP, Paris, France; Service de Dermatologie et Service d'Anatomo-Pathologie, Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France
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Seo YH, Lee YH, Ji JD, Song GG, Yoo SH, Ahn J, Choi SJ. A Case of Sweet's Syndrome Associated with Rheumatoid Arthritis Involving Multiple Skin Lesions. JOURNAL OF RHEUMATIC DISEASES 2013. [DOI: 10.4078/jrd.2013.20.3.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Young Ho Seo
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Young Ho Lee
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Jong Dae Ji
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Gwan Gyu Song
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Seu Hee Yoo
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Jemma Ahn
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Sung Jae Choi
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
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Lorente-Lavirgen AI, Pulpillo-Ruiz Á, Luque-Márquez R, Cabrera-Pérez R, Conejo-Mir J. Painful oral aphthae and myositis. Int J Dermatol 2012; 51:1239-41. [DOI: 10.1111/j.1365-4632.2011.05152.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Díaz-Corpas T, Mateu-Puchades A, Morales-Suárez-Varela M, Castells-Rodellas A. Retrospective Study of Patients Diagnosed With Sweet Syndrome in the Health Area of a Tertiary Hospital in the Autonomous Community of Valencia. ACTAS DERMO-SIFILIOGRAFICAS 2012. [DOI: 10.1016/j.adengl.2012.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Díaz-Corpas T, Mateu-Puchades A, Morales-Suárez-Varela M, Castells-Rodellas A. Estudio retrospectivo de pacientes diagnosticados de síndrome de Sweet en el área de un hospital terciario de la Comunidad Valenciana. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:233-7. [DOI: 10.1016/j.ad.2011.04.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Revised: 04/05/2011] [Accepted: 04/12/2011] [Indexed: 01/08/2023] Open
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Kirkland EB, Sachdev R, Kim J, Peng D. Early pancreatic panniculitis associated with HELLP syndrome and acute fatty liver of pregnancy. J Cutan Pathol 2011; 38:814-7. [PMID: 21752052 DOI: 10.1111/j.1600-0560.2011.01742.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Pancreatic panniculitis represents a rare cutaneous disorder most commonly associated with acute or chronic pancreatitis or pancreatic carcinoma. We describe a case of a 17-year-old woman who presented with a 2-day history of erythematous patches involving her bilateral knees and tender, scattered red-brown nodules involving her bilateral anterior shins. She was seen during a hospitalization for emergent cesarean section and her hospital course was complicated by HELLP syndrome (defined by the presence of hemolysis, elevated liver enzymes, low platelet count), acute fatty liver of pregnancy and pancreatitis. The characteristic histopathologic findings, including ghost cells, fat necrosis and granular basophilic material with dystrophic calcification, appear in later lesions. In early lesions, as was shown in this case, a neutrophilic subcutaneous infiltrate raises a differential diagnosis including infection, subcutaneous Sweet's syndrome or atypical erythema nodosum. To our knowledge, this represents the first report of pancreatic panniculitis in association with HELLP syndrome and acute fatty liver of pregnancy. Early recognition is critical, as skin lesions may precede the development of pancreatitis. Often, as in our case, the effects of pancreatitis may be life threatening.
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Affiliation(s)
- Eugene B Kirkland
- Department of Dermatology, Stanford University Medical Center, Stanford, CA, USA
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Terai T, Sugimoto M, Osawa S, Sugimoto K, Furuta T, Kanaoka S, Ikuma M. Successful treatment of ulcerative colitis complicated by Sweet’s syndrome by corticosteroid therapy and leukocytapheresis. Clin J Gastroenterol 2011; 4:151-156. [DOI: 10.1007/s12328-011-0215-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Accepted: 02/14/2011] [Indexed: 12/12/2022]
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20
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Dabade TS, Davis MDP. Diagnosis and treatment of the neutrophilic dermatoses (pyoderma gangrenosum, Sweet's syndrome). Dermatol Ther 2011; 24:273-84. [DOI: 10.1111/j.1529-8019.2011.01403.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Abstract
Sweet syndrome, also referred to as acute febrile neutrophilic dermatosis, is characterized by tender, red inflammatory nodules or papules that occur in association with infection, malignancy, connective tissue disease, or following exposure to certain drugs. Although drug-induced Sweet syndrome is rare, granulocyte colony-stimulating factor, all-trans-retinoic acid, and miscellaneous drugs have been implicated in causing this disorder in adults. In pediatric patients, granulocyte colony-stimulating factor, all-trans-retinoic acid, trimethoprim-sulfamethoxazole, and azathioprine have been implicated as potential causes of drug-induced Sweet syndrome. To date, six cases, including the patient reported here, have been reported in children.
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Affiliation(s)
- Mi Jin Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, South Korea
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Kim J, Choi YJ, Oh SH, Lee KH. A Case of Sweet's Panniculitis Associated with Spinal Metastasis from Prostate Cancer. Ann Dermatol 2010; 22:478-81. [PMID: 21165226 DOI: 10.5021/ad.2010.22.4.478] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 03/03/2010] [Accepted: 03/04/2010] [Indexed: 01/08/2023] Open
Abstract
Sweet's panniculitis is a rare variant of Sweet's syndrome in which neutrophilic infiltrate can be found either in the subcutaneous fat or in both the dermis and the subcutaneous tissue. Due to the rarity of this entity, the association between Sweet's panniculitis and malignancies is inconclusive, but cases of Sweet's panniculitis have largely been associated with hematological malignancies. Herein, we present a case of Sweet's panniculitis accompanied by bone metastasis from prostate cancer. Clinicians should be aware that Sweet's panniculitis may be associated with malignancies of solid organs.
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Affiliation(s)
- Jihyun Kim
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Abbas O, Kibbi AG, Rubeiz N. Sweet’s syndrome: retrospective study of clinical and histologic features of 44 cases from a tertiary care center. Int J Dermatol 2010; 49:1244-9. [DOI: 10.1111/j.1365-4632.2009.04233.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lund JJ, Stratman EJ, Jose D, Xia L, Wilson D, Moizuddin M. Drug-induced bullous sweet syndrome with multiple autoimmune features. Autoimmune Dis 2010; 2011:176749. [PMID: 21152216 PMCID: PMC2989706 DOI: 10.4061/2010/176749] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 06/25/2010] [Accepted: 08/01/2010] [Indexed: 11/26/2022] Open
Abstract
Sweet syndrome (SS) (Acute Febrile Neutrophilic Dermatosis) has been reported in association with autoimmune phenomena including relapsing polychondritis, drug-induced lupus, and the development of antineutrophil cytoplasmic antibodies (ANCAs). However, a combination of these autoimmune features has not been reported. Herein, we report a case of drug-induced bullous SS with ocular and mucosal involvement, glomerulonephritis, and multiple autoimmune features including clinical polychondritis with antitype II collagen antibodies, ANCAs, antinuclear (HEp-2), and antihistone antibodies in a patient on hydralazine and carbamazepine.
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Affiliation(s)
- Jared J Lund
- Department of Dermatology, Marshfield Clinic, 1000 N. Oak Avenue, Marshfield, 54449, USA
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Phua YS, Al-Ani SA, She RBW, de Chalain TM. Sweet's syndrome triggered by scalding: A case study and review of the literature. Burns 2010; 36:e49-52. [DOI: 10.1016/j.burns.2009.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2009] [Accepted: 05/15/2009] [Indexed: 10/20/2022]
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Barco D, Barnadas MA, Roé E, Sancho FJ, Ricart E, Alomar A. Neutrophilic dermatoses in a patient with collagenous colitis. Dermatol Reports 2010; 2:e5. [PMID: 25386241 PMCID: PMC4211476 DOI: 10.4081/dr.2010.e5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Revised: 01/22/2010] [Accepted: 01/22/2010] [Indexed: 11/23/2022] Open
Abstract
We report the case of a 75-year old woman with collagenous colitis who presented with erythematous and edematous plaques on the periorbital and eyelid regions, accompanied by oral ulcers. Histopathology showed a dermal neutrophilic infiltrate plus mild septal and lobular panniculitis with lymphocytes, neutrophils and eosinophils. Five years earlier she had presented a flare of papules and vesicles on the trunk, together with oral ulcers; a skin biopsy revealed a neutrophilic dermal infiltrate and Sweet’s syndrome was diagnosed. Both the neutrophilic panniculitis and the Sweet’s syndrome were accompanied by fever, malaise and diarrhea. Cutaneous and intestinal symptoms disappeared with corticoid therapy. The two types of neutrophilic dermatoses that appeared in periods of colitis activity suggest that intestinal and cutaneous manifestations may be related.
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Affiliation(s)
| | | | | | | | - Elena Ricart
- Department of Digestive Diseases, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Bangash SJ, Green WH, Dolson DJ, Cognetta AB. Eruptive postoperative squamous cell carcinomas exhibiting a pathergy-like reaction around surgical wound sites. J Am Acad Dermatol 2009; 61:892-7. [DOI: 10.1016/j.jaad.2009.01.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Revised: 11/20/2008] [Accepted: 01/25/2009] [Indexed: 10/20/2022]
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Johnson CS, May ER, Myers RK, Hostetter JM. Extracutaneous neutrophilic inflammation in a dog with lesions resembling Sweet's Syndrome. Vet Dermatol 2009; 20:200-5. [DOI: 10.1111/j.1365-3164.2009.00746.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chung HJ, Kim DH, Lee KY, Chung KY. Painful red plaques at injection sites. Am J Clin Dermatol 2009; 10:201-3. [PMID: 19354336 DOI: 10.2165/00128071-200910030-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Hye Jin Chung
- Department of Dermatology and Cutaneous Biology, Jefferson Medical College, Philadelphia, Pennsylvania, USA
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García-Salces I, Baldellou R, Hörndler C, Zubiri ML. Subcorneal pustular dermatosis with pathergy phenomenon in a patient with Crohn's disease. J Eur Acad Dermatol Venereol 2008; 23:349-50. [PMID: 18624859 DOI: 10.1111/j.1468-3083.2008.02866.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ocular Involvement in Acute Febrile Neutrophilic Dermatosis (Sweet Syndrome): New Cases and Review of the Literature. Surv Ophthalmol 2008; 53:219-26. [DOI: 10.1016/j.survophthal.2008.02.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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35
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Woo VL, Abdelsayed R. Oral manifestations of internal malignancy and paraneoplastic syndromes. Dent Clin North Am 2008; 52:203-x. [PMID: 18154871 DOI: 10.1016/j.cden.2007.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Malignant tumors of visceral organs are a fundamental feature of familial cancer and paraneoplastic syndromes. In many instances, the presence of an internal and often occult malignancy may be forewarned by various external manifestations. Several of these findings are preferentially localized to the head and neck region, including the oral cavity proper. This places the dental practitioner in a unique position to detect these "markers" of occult neoplastic involvement. Because these markers may present before an established syndrome or cancer diagnosis, even representing the first expression of disease in some cases, early recognition by a dentist may lead to timely diagnosis and management of these cancer-associated syndromes.
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Affiliation(s)
- Victoria L Woo
- Columbia University College of Dental Medicine, 630 West 168th Street, PH 1562 West, New York, NY 10032, USA.
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Goikoetxea U, Eguiluz A, Lobo C, Cosme A, Ojeda E, Bujanda L. [Sweet's syndrome and arthritis in a patient with ulcerative colitis]. GASTROENTEROLOGIA Y HEPATOLOGIA 2007; 30:506-7. [PMID: 17949618 DOI: 10.1157/13110496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
BACKGROUND Sweet's syndrome is well recognized by dermatologists and is not infrequently diagnosed in Iran; however, few case series have been reported. METHODS A clinicopathologic study was carried out on 15 cases of Sweet's syndrome in Hamedan, in the west of Iran, between 1994 and 2004. RESULTS The incidence of Sweet's syndrome was 3 per 10,000 amongst new dermatologic patients. All were women with a mean age of 58 years. All 15 cases were of the classic type, with no associated diseases. Fever was seen in only six (40%) patients. CONCLUSIONS Sweet's syndrome has a broad spectrum of clinical and pathologic findings in various areas of the world. Further investigation is necessary to determine the etiology and effect of environmental factors in this disease.
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Cohen PR. Sweet's syndrome--a comprehensive review of an acute febrile neutrophilic dermatosis. Orphanet J Rare Dis 2007; 2:34. [PMID: 17655751 PMCID: PMC1963326 DOI: 10.1186/1750-1172-2-34] [Citation(s) in RCA: 490] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2007] [Accepted: 07/26/2007] [Indexed: 01/19/2023] Open
Abstract
Sweet's syndrome (the eponym for acute febrile neutrophilic dermatosis) is characterized by a constellation of clinical symptoms, physical features, and pathologic findings which include fever, neutrophilia, tender erythematous skin lesions (papules, nodules, and plaques), and a diffuse infiltrate consisting predominantly of mature neutrophils that are typically located in the upper dermis. Several hundreds cases of Sweet's syndrome have been published. Sweet's syndrome presents in three clinical settings: classical (or idiopathic), malignancy-associated, and drug-induced. Classical Sweet's syndrome (CSS) usually presents in women between the age of 30 to 50 years, it is often preceded by an upper respiratory tract infection and may be associated with inflammatory bowel disease and pregnancy. Approximately one-third of patients with CSS experience recurrence of the dermatosis. The malignancy-associated Sweet's syndrome (MASS) can occur as a paraneoplastic syndrome in patients with an established cancer or individuals whose Sweet's syndrome-related hematologic dyscrasia or solid tumor was previously undiscovered; MASS is most commonly related to acute myelogenous leukemia. The dermatosis can precede, follow, or appear concurrent with the diagnosis of the patient's cancer. Hence, MASS can be the cutaneous harbinger of either an undiagnosed visceral malignancy in a previously cancer-free individual or an unsuspected cancer recurrence in an oncology patient. Drug-induced Sweet's syndrome (DISS) most commonly occurs in patients who have been treated with granulocyte-colony stimulating factor, however, other medications may also be associated with DISS. The pathogenesis of Sweet's syndrome may be multifactorial and still remains to be definitively established. Clinical and laboratory evidence suggests that cytokines have an etiologic role. Systemic corticosteroids are the therapeutic gold standard for Sweet's syndrome. After initiation of treatment with systemic corticosteroids, there is a prompt response consisting of dramatic improvement of both the dermatosis-related symptoms and skin lesions. Topical application of high potency corticosteroids or intralesional corticosteroids may be efficacious for treating localized lesions. Other first-line oral systemic agents are potassium iodide and colchicine. Second-line oral systemic agents include indomethacin, clofazimine, cyclosporine, and dapsone. The symptoms and lesions of Sweet's syndrome may resolved spontaneously, without any therapeutic intervention; however, recurrence may follow either spontaneous remission or therapy-induced clinical resolution.
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Affiliation(s)
- Philip R Cohen
- University of Houston Health Center, Houston, Texas, USA.
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Neoh CY, Tan AWH, Ng SK. Sweet's syndrome: a spectrum of unusual clinical presentations and associations. Br J Dermatol 2007; 156:480-5. [PMID: 17300237 DOI: 10.1111/j.1365-2133.2006.07677.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sweet's syndrome (SS) is the prototypic neutrophilic dermatosis. First described in 1964, the characterization of new clinical associations, unique histopathological findings and clinical variants have stimulated much interest and discussion recently. However, the prevalence of these unusual variants and clinical associations within a single cohort of patients, has not been described. OBJECTIVES To describe and evaluate the prevalence of unusual clinical and histopathological features, as well as the clinical associations of SS seen in patients from the National Skin Centre, Singapore. METHODS This is a retrospective study of all consecutive cases of SS seen at our centre over a 5.5-year period (June 1999-December 2004). Data on associated systemic diseases was obtained from the medical records and matched with information from the National Cancer Registry, Singapore. Patients not actively followed up for more than 3 months were contacted for their updated health status. RESULTS Thirty-seven patients were identified. Ten (27%) had non-idiopathic SS. These were associated with haematological disorders, connective tissue disorders, infections or a drug. Twenty-nine patients (78%) had at least one atypical clinical or histopathological feature. Atypical clinical features included bullous lesions, SS with hand involvement or neutrophilic dermatoses of the hands and the concomitant existence of subcutaneous SS with pyoderma gangrenosum. SS was the presenting feature in three patients with infections caused by atypical organisms, including Mycobacterium chelonae, Penicillium species and Salmonella type D. Unique histopathological variants included subcutaneous SS and lesions containing an admixture of mature and immature neutrophils. Subcutaneous neutrophilic inflammation seemed to be more common in patients with an underlying haematological disorder. This group of patients also had a lower mean haemoglobin level. CONCLUSIONS Unusual clinical and histopathological variants of SS described in the literature are similarly encountered in our cohort of patients, with some features being more common than others. We highlight and discuss some unique clinical and histopathological observations seen in our patients with SS.
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Affiliation(s)
- C Y Neoh
- National Skin Centre, 1 Mandalay Road, Singapore, Singapore.
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Abstract
Erythema nodosum is the most frequent clinicopathologic variant of panniculitis. The process is a cutaneous reaction that may be associated with a wide variety of disorders, including infections, sarcoidosis, rheumatologic diseases, inflammatory bowel diseases, medications, autoimmune disorders, pregnancy, and malignancies. Erythema nodosum typically manifest by the sudden onset of symmetrical, tender, erythematous, warm nodules and raised plaques usually located on the lower limbs. Often the lesions are bilaterally distributed. At first, the nodules show a bright red color, but within a few days they become livid red or purplish and, finally, they exhibit a yellow or greenish appearance, taking on the look of a deep bruise. Ulceration is never seen, and the nodules heal without atrophy or scarring. Histopathologically, erythema nodosum is the stereotypical example of a mostly septal panniculitis with no vasculitis. The septa of subcutaneous fat are always thickened and variously infiltrated by inflammatory cells that extend to the periseptal areas of the fat lobules. The composition of the inflammatory infiltrate in the septa varies with age of the lesion. In early lesions edema, hemorrhage, and neutrophils are responsible for the septal thickening, whereas fibrosis, periseptal granulation tissue, lymphocytes, and multinucleated giant cells are the main findings in late stage lesions of erythema nodosum. A histopathologic hallmark of erythema nodosum is the presence of the so-called Miescher's radial granulomas, which consist of small, well-defined nodular aggregations of small histiocytes arranged radially around a central cleft of variable shape. Treatment of erythema nodosum should be directed to the underlying associated condition, if identified. Usually, nodules of erythema nodosum regress spontaneously within a few weeks, and bed rest is often sufficient treatment. Aspirin, nonsteroidal antiinflammatory drugs, such as oxyphenbutazone, indomethacin or naproxen, and potassium iodide may be helpful drugs to enhance analgesia and resolution. Systemic corticosteroids are rarely indicated in erythema nodosum and before these drugs are administered an underlying infection should be ruled out.
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Affiliation(s)
- Luis Requena
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain.
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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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Ginarte M, Toribio J. Sweet's syndrome and erythema nodosum: two neutrophilic dermatoses? Clin Rheumatol 2007; 26:1215-6. [PMID: 17294051 DOI: 10.1007/s10067-007-0564-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Accepted: 01/19/2007] [Indexed: 10/23/2022]
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Pérez Rodríguez MT, Martínez-Ares D, Martín-Granizo I, Pallarés Peral A. Síndrome de Sweet y eritema nudoso en una paciente con enfermedad de Crohn. Med Clin (Barc) 2007; 128:156-7. [PMID: 17288941 DOI: 10.1016/s0025-7753(07)72519-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Martínez W, del Pozo J, Peña C, Yebra-Pimentel MT, Almagro M, Rodríguez-Lozano J, Fonseca E. Sweet's syndrome in a woman with chronic dermatophytic infection. Int J Dermatol 2007; 45:1365-8. [PMID: 17076728 DOI: 10.1111/j.1365-4632.2006.02890.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Walter Martínez
- Department of Dermatology, Hospital Juan Canalejo, La Coruña, 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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Mahajan VK, Sharma NL, Sharma RC. Sweet's syndrome from an Indian perspective: a report of four cases and review of the literature. Int J Dermatol 2006; 45:702-8. [PMID: 16796632 DOI: 10.1111/j.1365-4632.2006.02622.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Sweet's syndrome or acute febrile neutrophilic dermatosis is not frequently reported from India. Four patients fulfilling clinico-pathologic criteria for Sweet's syndrome seen during May-August 2002 prompted us to review reports on Indian patients from the indexed literature. METHODS A PubMed and IndMed search for Sweet's syndrome revealed 11 reports appearing between 1985-2002 documenting 12 patients. The clinico-pathologic features, clinical course and treatment of all these 16 patients (including four new cases) were studied. RESULTS The study comprised 12 females and four males between 35 days to 57 years of age. There were four children of < 12 years. Ulcerated, crusted lesions in one and typical, erythematous, tender, papulo-nodulo-plaques and targetoid lesions with pseudovesiculation were observed in 13 other patients particularly involving head, neck and upper limbs. Extracutaneous Sweet's syndrome manifesting as gingival hyperplasia and myositis was seen in one patient each. All had simultaneous onset of cutaneous lesions, fever, headache and malaise. Ocular involvement was observed in four patients only. Associated hematoligic disorders recorded were myelodysplasia in three, polycythemia vera in one and leukemia in three patients respectively. Two of these patients had treatment with all-transretinoic acid and low-dose cytosine-arbinoside before onset of Sweet's syndrome. One patient each had symptoms of upper respiratory tract infection and history of minor injury prior to cutaneous lesions. Another patient had pregnancy induced self-limiting Sweet's syndrome. Leukocytosis was present in 11 patients. Three of four new patients had positive tests for antistreptolysin-O and C-reactive protein. Characteristics histologic features were recorded in specimens of all patients. Eleven patients responded to systemic corticosteroids. Colchicin or potassium iodide were effective in one patient each. CONCLUSION The overall clinico-pathologic and therapeutic spectrum of Sweet's syndrome in Indian patients does not appear to be different from its established picture.
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Affiliation(s)
- Vikram K Mahajan
- Department of Dermatology, Venereology and Leprosy, Indira Gandhi Medical College, Shimla, India
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Saliba WR, Habib GS, Elias M. Sweet's syndrome and sarcoidosis. Eur J Intern Med 2005; 16:545-50. [PMID: 16314234 DOI: 10.1016/j.ejim.2005.06.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2004] [Revised: 05/12/2005] [Accepted: 06/02/2005] [Indexed: 10/25/2022]
Abstract
In this review we summarize a number of cases of Sweet's syndrome (SS) associated with sarcoidosis that have been reported in the English literature. In all of the cases, the two disorders were diagnosed simultaneously. Patients with both disorders were younger and had a higher rate of fever than patients with SS alone. In this group of patients, we found a trend toward less skin involvement of the face and trunk, more involvement of the upper limbs, and more atypical skin lesions, particularly papules. The association of the two disorders seems to be more related to a subset of acute sarcoidosis (Lofgren's syndrome). All of the patients in this group had a benign course and self-limiting disease. Thus, SS in association with sarcoidosis could be considered a favorable prognostic factor. Although SS has a high rate of recurrence, no recurrence occurred in this group of patients during follow-up.
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Affiliation(s)
- W R Saliba
- Department of Internal Medicine C, Hae'meK Medical Center, Afula 18101, Israel.
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Sáez M, García-Bustínduy M, Noda A, Dorta S, Escoda M, Fagundo E, Rodríguez F, Guimerá F, Sánchez R, García-Montelongo R. Drug-induced Sweet's syndrome. J Eur Acad Dermatol Venereol 2004; 18:233. [PMID: 15009320 DOI: 10.1111/j.1468-3083.2004.00866.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Paoluzi OA, Crispino P, Amantea A, Pica R, Iacopini F, Consolazio A, Di Palma V, Rivera M, Paoluzi P. Diffuse febrile dermatosis in a patient with active ulcerative colitis under treatment with steroids and azathioprine: a case of Sweet's syndrome. Case report and review of literature. Dig Liver Dis 2004; 36:361-6. [PMID: 15191207 DOI: 10.1016/j.dld.2003.10.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Ulcerative colitis is an inflammatory bowel disease often associated with extra-intestinal manifestations, such as dermatological disorders. Of these, the most frequent are erythema nodosum and pyoderma gangrenosum, the two neutrophilic forms of dermatosis. Another is Sweet' s syndrome, which results in a sudden eruption of tender, raised erythematous or violaceous plaques/papules or nodules, less frequent vesicles, pustules or bullae, involving face, neck, arms and trunk. This skin disorder is frequently observed in patients with leukaemia or connective tissue diseases, while it is very rare in patients with inflammatory bowel disease. The present report deals with the case of a febrile diffuse skin eruption in a 53-year-old patient with moderately active ulcerative colitis after few days' treatment with steroids and azathioprine. At first, the dermatosis was addressed to an idiosyncrasy to azathioprine, which was, therefore, promptly discontinued. Histological examination of skin biopsies revealed the presence of features typical of a Sweet's syndrome. The eruption gradually improved as well as the patient's general condition, until complete regression was achieved following steroid treatment.
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Affiliation(s)
- O A Paoluzi
- Department of Clinical Science, Gastroenterology Unit, La Sapienza University, Viale del Policlinico 157, 00161 Rome, Italy
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Abstract
Sweet's syndrome, also referred to as acute febrile neutrophilic dermatosis, is characterized by a constellation of symptoms and findings: fever, neutrophilia, erythematous and tender skin lesions that typically show an upper dermal infiltrate of mature neutrophils, and prompt improvement of both symptoms and lesions after the initiation of treatment with systemic corticosteroids. Hundreds of patients with this dermatosis have been reported. The manifestations of Sweet's syndrome in these individuals have not only confirmed those originally described by Dr Robert Douglas Sweet in 1964, but have also introduced new features that have expanded the clinical and pathologic concepts of this condition. The history, clinical characteristics, laboratory findings, associated diseases, pathology, and treatment options of Sweet's syndrome are reviewed. The evolving and new concepts of this dermatosis that are discussed include: (i) Sweet's syndrome occurring in the clinical setting of a disease-related malignancy, or medication, or both; (ii) detection of additional sites of extracutaneous Sweet's syndrome manifestations; (iii) discovery of additional Sweet's syndrome-associated diseases; (iv) variability of the composition and/or location of the cutaneous inflammatory infiltrate in Sweet's syndrome lesions; and (v) additional efficacious treatments for Sweet's syndrome.
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Affiliation(s)
- Philip R Cohen
- University of Houston Health Center, Department of Dermatology, The University of Texas-Houston Medical School, Houston, Texas, USA.
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