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Barbosa E, O'Keeffe C, O'Kane M. Sweet syndrome: a retrospective analysis of 16 patients from a tertiary care center. Int J Dermatol 2022; 61:e391-e393. [PMID: 35383911 DOI: 10.1111/ijd.16188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/07/2022] [Accepted: 03/13/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Elsa Barbosa
- Department of Dermatology, Beaumont Hospital, Dublin, Ireland
| | - Ciara O'Keeffe
- Department of Dermatology, Beaumont Hospital, Dublin, Ireland
| | - Marina O'Kane
- Department of Dermatology, Beaumont Hospital, Dublin, Ireland
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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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Nelson CA, Stephen S, Ashchyan HJ, James WD, Micheletti RG, Rosenbach M. Neutrophilic dermatoses: Pathogenesis, Sweet syndrome, neutrophilic eccrine hidradenitis, and Behçet disease. J Am Acad Dermatol 2018; 79:987-1006. [PMID: 29653210 DOI: 10.1016/j.jaad.2017.11.064] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/06/2017] [Accepted: 11/08/2017] [Indexed: 12/24/2022]
Abstract
Neutrophilic dermatoses are a heterogeneous group of inflammatory skin disorders that present with unique clinical features but are unified by the presence of a sterile, predominantly neutrophilic infiltrate on histopathology. The morphology of cutaneous lesions associated with these disorders is heterogeneous, which renders diagnosis challenging. Moreover, a thorough evaluation is required to exclude diseases that mimic these disorders and to diagnose potential associated infectious, inflammatory, and neoplastic processes. While some neutrophilic dermatoses may resolve spontaneously, most require treatment to achieve remission. Delays in diagnosis and treatment can lead to significant patient morbidity and even mortality. Therapeutic modalities range from systemic corticosteroids to novel biologic agents, and the treatment literature is rapidly expanding. The first article in this continuing medical education series explores the pathogenesis of neutrophilic dermatoses and reviews the epidemiology, clinical and histopathologic features, diagnosis, and management of Sweet syndrome, neutrophilic eccrine hidradenitis, and Behçet disease.
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Affiliation(s)
- Caroline A Nelson
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sasha Stephen
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hovik J Ashchyan
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - William D James
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert G Micheletti
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Misha Rosenbach
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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Marcoval J, Martín-Callizo C, Valentí-Medina F, Bonfill-Ortí M, Martínez-Molina L. Sweet syndrome: long-term follow-up of 138 patients. Clin Exp Dermatol 2016; 41:741-6. [DOI: 10.1111/ced.12899] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2015] [Indexed: 01/23/2023]
Affiliation(s)
- J. Marcoval
- Department of Dermatology; Hospital de Bellvitge; IDIBELL; University of Barcelona; Barcelona Spain
| | - C. Martín-Callizo
- Department of Dermatology; Hospital de Bellvitge; IDIBELL; University of Barcelona; Barcelona Spain
| | - F. Valentí-Medina
- Department of Dermatology; Hospital de Bellvitge; IDIBELL; University of Barcelona; Barcelona Spain
| | - M. Bonfill-Ortí
- Department of Dermatology; Hospital de Bellvitge; IDIBELL; University of Barcelona; Barcelona Spain
| | - L. Martínez-Molina
- Department of Dermatology; Hospital de Bellvitge; IDIBELL; University of Barcelona; Barcelona Spain
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Amouri M, Masmoudi A, Ammar M, Boudaya S, Khabir A, Boudawara T, Turki H. Sweet's syndrome: a retrospective study of 90 cases from a tertiary care center. Int J Dermatol 2016; 55:1033-9. [PMID: 26967709 DOI: 10.1111/ijd.13232] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 10/19/2015] [Accepted: 11/04/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND Sweet's syndrome (SS) is a neutrophilic dermatosis characterized by the abrupt onset of cutaneous, systemic and histopathological alterations in response to different stimuli. OBJECTIVES The aim of this study was to assess the epidemioclinical, histological, and therapeutic features and outcomes of SS. METHODS A retrospective study of all patients diagnosed with SS over a 20-year period (1993-2012) was conducted. Data were analyzed using a level of significance of 5%. RESULTS Ninety patients (mean age: 46.5 years) fulfilled the inclusion criteria. The ratio of women to men was 5. Significant associations emerged between dermohypodermic nodes and location on the lower limbs (P = 0.042), and vesiculobullous lesions and location on the legs (P = 0.030), dorsum of the hand (P = 0.015), and forearms (P = 0.003), and paraneoplastic forms (P = 0.012). The upper extremities were involved in the majority of patients (83.3%). Correlations were found between edema of the superficial dermis and vesiculobullous lesions and between leukocytoclastic vasculitis and atypical targetoid lesions. Sweet's syndrome was associated with cytomegalovirus infection (n = 1), inflammatory bowel disease (n = 4), neoplasm (n = 6), and pregnancy (n = 3). First-line treatment consisted of colchicine. CONCLUSIONS To the best of the present authors' knowledge, this is the largest series of SS to be reported. Clinical presentations are similar to those described in the literature. Colchicine was efficient and facilitates the reduced use of corticosteroids. The association between SS and neoplasms should be considered in the context of vesiculobullous lesions.
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Affiliation(s)
- Meriem Amouri
- Department of Dermatology, Hedi Chaker Hospital, Sfax, Tunisia
| | | | - Morsi Ammar
- Department of Dermatology, Hedi Chaker Hospital, Sfax, Tunisia
| | - Sonia Boudaya
- Department of Dermatology, Hedi Chaker Hospital, Sfax, Tunisia
| | - Abdelmajid Khabir
- Department of Anatomopathology, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Tahia Boudawara
- Department of Anatomopathology, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Hamida Turki
- Department of Dermatology, Hedi Chaker Hospital, Sfax, Tunisia
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Chavan RN, Cappel MA, Ketterling RP, Wada DA, Rochet NM, Knudson R, Gibson LE. Histiocytoid Sweet syndrome may indicate leukemia cutis: A novel application of fluorescence in situ hybridization. J Am Acad Dermatol 2014; 70:1021-7. [DOI: 10.1016/j.jaad.2014.01.874] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 01/13/2014] [Accepted: 01/25/2014] [Indexed: 01/01/2023]
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Sweet syndrome: clinical presentation, associations, and response to treatment in 77 patients. J Am Acad Dermatol 2013; 69:557-64. [PMID: 23891394 DOI: 10.1016/j.jaad.2013.06.023] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 06/12/2013] [Accepted: 06/13/2013] [Indexed: 01/09/2023]
Abstract
BACKGROUND Sweet syndrome is a neutrophilic dermatosis with cutaneous tender lesions that can be associated with malignancies, infections, systemic inflammatory disorders, and medications. Although numerous studies have described Sweet syndrome, few studies have systematically investigated Sweet syndrome. OBJECTIVE We sought to describe characteristics and treatments of patients with Sweet syndrome and evaluate clinical differences depending on the underlying cause. METHODS A retrospective study was conducted to identify patients with Sweet syndrome evaluated at Mayo Clinic from 1992 to 2010. RESULTS Of 77 patients with Sweet syndrome (mean age of onset 57 years), 43 (56%) were male. Eighteen patients (23%) reported a preceding infection. A total of 41 (53%) patients were classified as having classic Sweet syndrome, 27 (35%) patients had malignancy-associated Sweet syndrome, and in 9 (12%) patients drug-induced Sweet syndrome was considered. In all, 21 patients had a hematologic malignancy or myeloproliferative/myelodysplastic disorder, whereas 6 patients had solid tumors. The mean hemoglobin level, in both male and female patients (P < .0443 and P < .0035, respectively), was significantly lower in malignancy-associated versus classic and drug-induced Sweet syndrome. Systemic corticosteroids were the most frequently used treatment (70%). LIMITATIONS This is a retrospective study and represents patients from a single academic center. CONCLUSIONS Sweet syndrome is a distinctive disorder with certain clinical and histologic characteristics, which usually has a complete response to systemic corticosteroids. It is important to evaluate Sweet syndrome patients who have laboratory evidence of anemia for an underlying malignancy.
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Eleuterio IA, Tiussi RM, Delmaestro D, Diniz LM, Lucas EA. Sweet's syndrome: clinicopathological features of patients treated from 1997 to 2009 at Cassiano Antonio Moraes University Hospital - Vitoria (Espirito Santo). An Bras Dermatol 2012; 87:450-5. [DOI: 10.1590/s0365-05962012000300014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2010] [Accepted: 02/14/2011] [Indexed: 02/07/2023] Open
Abstract
Sweet's syndrome or acute febrile neutrophilic dermatosis is rare in Brazil. It is clinically characterized by painful erythematous nodules, papules or plaques that occur mainly on the neck and upper limbs. Its cause may be unknown (idiopathic form) or it may be associated with malignancies, usually hematologic, or drugs. The authors describe 16 cases of the syndrome. The median age was 36 years, and all patients were white and presented solid lesions, predominantly on the upper limbs and trunk. Histopathological examination of the dermis of all patients revealed predominance of moderate to intense, superficial and deep, diffuse inflammatory infiltrate, mainly consisting of polymorphonuclear neutrophils, with leukocytoclasia. It also revealed changes in the epidermis and hypodermis (neutrophilic hypodermitis), but with no signs of vasculitis in most patients, which was not considered an important finding for diagnosis. Presence of exocytosis of neutrophils was common, favoring the diagnosis of Sweet's syndrome when accompanied by diffuse interstitial neutrophilic dermatitis.
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Affiliation(s)
| | | | | | - Lucia Martins Diniz
- Federal University of Rio de Janeiro; Federal University of Espirito Santo, Brazil
| | - Elton Almeida Lucas
- Federal University of Espirito Santo; Federal University of Espirito Santo, Brazil
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Ilias Basha H, Towfiq B, Krznarich TS. Sweet's syndrome as a dermatological manifestation of underlying coronary artery disease. J Cardiol Cases 2012; 6:e8-e12. [PMID: 30546715 DOI: 10.1016/j.jccase.2012.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 01/30/2012] [Accepted: 03/09/2012] [Indexed: 01/16/2023] Open
Abstract
We report an unusual case of a 50-year-old female with no significant past medical history who reported with a sudden eruption of painful erythematous papules accompanied by fever. Clinical and pathological findings were consistent with acute febrile neutrophilic dermatosis (or Sweet's syndrome). Two weeks later, she complained of chest pain and was diagnosed with non-ST elevation myocardial infarction. Coronary angiogram demonstrated stenosis of right coronary artery and left Circumflex artery. Subsequent workup to identify underlying malignant or autoimmune disorders was negative. She refused to undergo percutaneous coronary intervention and was treated conservatively with steroids, resulting in dramatic resolution of skin lesions. Six months later, the patient was readmitted with similar complaints including fever, generalized rash, and chest pain. Electrocardiography demonstrated old infero-lateral wall infarction. Cardiac enzymes were not elevated. Repeat workup failed to identify underlying systemic disorder except coronary artery disease (CAD). She recovered following administration of steroids and continued to receive medical therapy for CAD. This case demonstrates an unusual association between Sweet's syndrome and CAD in an adult female. Sweet's syndrome is considered to be a reactive phenomenon of underlying systemic disorders. Therefore, patients presenting with Sweet's syndrome should be evaluated for CAD, especially in the absence of underlying malignant or autoimmune disorders.
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Affiliation(s)
- Haseeb Ilias Basha
- Department of Internal Medicine, Michigan State University College of Human Medicine, East Lansing, MI, USA.,Department of Internal Medicine, Hurley Medical Center, Flint, MI, USA
| | - Basim Towfiq
- Department of Internal Medicine, Michigan State University College of Human Medicine, East Lansing, MI, USA.,Department of Internal Medicine, Hurley Medical Center, Flint, MI, USA
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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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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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