1
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Lo A, Thompson B, Sami N. Rare Autoinflammatory Neutrophilic Dermatoses in Pregnancy: Literature Review. Am J Clin Dermatol 2024; 25:227-242. [PMID: 38091248 DOI: 10.1007/s40257-023-00830-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2023] [Indexed: 02/16/2024]
Abstract
Rare cases of autoinflammatory neutrophilic dermatoses (AINDs) have been reported in patients during pregnancy with associated adverse maternal and fetal outcomes. Due to the rarity and heterogeneous morphology of pregnancy-associated AINDs, clinical diagnosis is often overlooked, and treatment options are limited. In this review, we present the epidemiology, clinical characteristics, therapeutic interventions, maternal and fetal outcomes, and discuss the possible pathophysiology of various pregnancy associated AINDs. Risk factors for the onset and exacerbation of AINDs in pregnancy include older maternal age, disease duration, and specific gestational age. The varied disease courses and conflicting clinical outcomes in both mothers and fetuses demonstrate the importance of symptom recognition and the understanding of the role of pregnancy on AINDs.
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Affiliation(s)
- Angela Lo
- University of Central Florida College of Medicine, Orlando, FL, USA
| | | | - Naveed Sami
- Department of Internal Medicine, University of Central Florida College of Medicine, Health Sciences Campus at Lake Nona, Orlando, FL, 32827-7408, USA.
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2
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Koska MC, Karadağ AS, Durdu M. Annular neutrophilic dermatoses. Clin Dermatol 2023; 41:340-354. [PMID: 37423267 DOI: 10.1016/j.clindermatol.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Neutrophilic dermatoses (NDs) constitute a group of diseases characterized by sterile neutrophilic infiltrations. Many NDs usually present with infiltrated erythematous plaques, nodules, urticarial plaques, or pustules. Lesions may show variability, and atypical presentations may develop among NDs. Annular lesions have been reported in many NDs and may lead to diagnostic problems. Clinical features and histopathologic findings such as localization of the neutrophilic infiltrate, existence of other cell types, and absence of true vasculitis may be helpful to distinguish NDs. Some of these NDs are associated with infections, inflammatory diseases, and malignancies. In most NDs, systemic steroids and dapsone are very effective and usually first choices. Colchicine, antimicrobials such as doxycycline, tetracycline, and sulfapyridine, and other immunosuppressants such as cyclosporin, methotrexate, and mycophenolate mofetil have been used successfully in treating many NDs. Tumor necrosis factor α inhibitors have also been used successfully in treating many NDs. Janus kinase inhibitors are effective in CANDLE (chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature) syndrome, anakinra in neutrophilic urticarial dermatosis, and intravenous immunoglobulin in resistant pyoderma gangrenosum. We discuss the diagnosis and management of NDs that may present with annular lesions.
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Affiliation(s)
- Mahmut Can Koska
- Dermatology and Venereology Clinic, Artvin State Hospital, Artvin, Turkey.
| | - Ayşe Serap Karadağ
- Department of Dermatology, Istanbul Arel University Medical Faculty, Istanbul, Turkey
| | - Murat Durdu
- Department of Dermatology, Başkent University Faculty of Medicine, Adana Dr. Turgut Noyan Application and Research Center, Adana, Turkey
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3
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Ma M, Wei S, Yin D, Li W, Li C. A Case of Neutrophilic Dermatoses-Sweet’s Syndrome Coexisting with SAPHO Syndrome. Clin Cosmet Investig Dermatol 2023; 16:739-742. [PMID: 37008190 PMCID: PMC10065417 DOI: 10.2147/ccid.s404390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023]
Abstract
SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome is a rare disease characterized by osteoarticular and cutaneous manifestations. SAPHO syndrome mostly involves the skin, mainly presented as palmoplantar pustulosis and severe acne. Sweet's syndrome (SS) is a neutrophilic dermatosis of unknown cause, which may be caused by autoinflammation. So far, SAPHO syndrome complicated with SS has been rarely reported worldwide. Here, we present a rare case diagnosed in our hospital with detailed clinical information. This patient presented pain and swelling in her right leg. Later, she developed red papules on her right lower eyelid and a skin biopsy showed diffuse lymphocytic and neutrophilic infiltration in the superficial dermis. She was diagnosed with SAPHO syndrome and SS according to medical history and examination. These two diseases share parts of autoinflammatory signaling pathways and might be different variations of the spectrum of autoinflammatory diseases. Through this case, we aim to provide a new horizon for the regulation of neutrophils in SAPHO syndrome and skin lesions like SS.
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Affiliation(s)
- Mingwei Ma
- School of Clinical Medicine, Peking Union Medical College Hospital (PUMC and CAMS), Beijing, 100730, People’s Republic of China
| | - Shufeng Wei
- Department of Rheumatology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, 102401, People’s Republic of China
| | - Dan Yin
- Department of Rheumatology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, 102401, People’s Republic of China
| | - Weizhong Li
- Department of Rheumatology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, 102401, People’s Republic of China
| | - Chen Li
- Department of Rheumatology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, 102401, People’s Republic of China
- Correspondence: Chen Li, Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine, No. 4, Chengguan Health Road, Fangshan District, Beijing, People’s Republic of China, Tel +86 13810988688, Email
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4
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Chakiri R, Baybay H, Hatimi AE, Gallouj S, Harmouch T, Mernissi FZ. Clinical and histological patterns and treatment of pyoderma gangrenosum. Pan Afr Med J 2020; 36:59. [PMID: 32733629 PMCID: PMC7371440 DOI: 10.11604/pamj.2020.36.59.12329] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 07/08/2017] [Indexed: 11/24/2022] Open
Abstract
Pyoderma gangrenosum (PG) is a rare inflammatory neutrophilic dermatosis for which accurate epidemiological data are limited and therapy remains a challenge. The primary study’s aim was to examine all cases of PG observed in our department over a 6-year period in order to describe the relevant characteristics and outcome under therapy. Fourteen patients were included (5 women, 9 men). The average age of our patients was 40,15 years. The classical, ulcerative form was found in 10 cases (71.42%), the pustular form in 4 cases (27.57%) and PG was multifocal in 4 cases. The PG was located preferentially to the lower limbs. Histological examination was realized in all patients and objectified inflammatory infiltrate composed of polymorphonuclear neutrophils in all cases with vasculitis in 4 cases. Six patients (42.85%) had associated disease at diagnosis of PG, including inflammatory bowel disease in two cases (14.28%), a blood disease in 2 cases (14.28%), lymph node tuberculosis and inflammatory arthritis in 1 case (7%). The most frequent first-line treatments were oral corticosteroids (7 cases) and other treatments used were colchicine in 2 cases, topical corticosteroids in 3 cases with good clinical evolution. Our study confirms that PG is a rare disease, associated in almost half of cases with systemic disease already present at diagnosis; in our Moroccan background, it is most often inflammatory bowel disease, hematological or solid cancer and tuberculosis.
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Affiliation(s)
- Radia Chakiri
- Department of Dermatology, University Hospital Hassan II, Fez, Morocco
| | - Hanane Baybay
- Department of Dermatology, University Hospital Hassan II, Fez, Morocco
| | - Asmae El Hatimi
- Department of Dermatology, University Hospital Hassan II, Fez, Morocco
| | - Salim Gallouj
- Department of Dermatology, University Hospital Hassan II, Fez, Morocco
| | - Taoufiq Harmouch
- Department of Anatomopathology, University Hospital Hassan II, Fez, Morocco
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5
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Xu P, Cai Y, Ying X, Shi S, Song W. A case of persistent fever, cutaneous manifestations and pulmonary and splenic nodules: clinical experience and a literature review. Intern Med J 2019; 49:247-251. [PMID: 30754076 PMCID: PMC6849849 DOI: 10.1111/imj.14201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/13/2018] [Accepted: 08/17/2018] [Indexed: 11/27/2022]
Abstract
Pyoderma gangrenosum (PG) is a rare and recurrent ulcerating, non‐infectious, inflammatory dermatosis, with occasional concomitant extracutaneous manifestations. The pathogenesis and aetiology of PG are unknown. Moreover, early diagnosis is challenging because there are several visceral manifestations that may occur prior to the skin findings, such that misdiagnosis of PG as an infection is common. Here, we present a case of PG in which pulmonary and spleen lesions preceded the cutaneous manifestations. The correct diagnosis was made 6 months after multiple nodules were detected in the lung and spleen, based on the development of skin wound ulcers. To the best of our knowledge, this is the first report of PG in which pulmonary and splenic involvement preceded the appearance of skin lesions, without systemic disease. The patient was followed up for 5 years, during which time complete clinical and radiographic resolution was confirmed. This case demonstrates the challenges in the diagnosis of PG and the importance of using multiple diagnostic methods to determine the cause of unexplained clinical manifestations.
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Affiliation(s)
- Ping Xu
- Department of Respiratory, Peking University Shenzhen Hospital, Shenzhen, Gangdong, China
| | - Yazhou Cai
- Department of Respiratory, Peking University Shenzhen Hospital, Shenzhen, Gangdong, China
| | - Xiaona Ying
- Department of Respiratory, Peking University Shenzhen Hospital, Shenzhen, Gangdong, China
| | - Shiqiao Shi
- Department of Diagnostic Radiology, Peking University Shenzhen Hospital, Shenzhen, Gangdong, China
| | - Weidong Song
- Department of Respiratory, Peking University Shenzhen Hospital, Shenzhen, Gangdong, China
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6
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Yang DH, Yang MY. Scrotal Pyoderma Gangrenosum Associated with Evans Syndrome. J Clin Med 2018; 7:jcm7090230. [PMID: 30131462 PMCID: PMC6162813 DOI: 10.3390/jcm7090230] [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: 07/28/2018] [Revised: 08/16/2018] [Accepted: 08/21/2018] [Indexed: 11/21/2022] Open
Abstract
Evans syndrome is a rare disorder with presentations of autoimmune hemolytic anemia and immune thrombocytopenia, in the absence of any underlying cause. Here, we reported a case with a history of Evans syndrome for seven years. A persistent scrotal ulcer with severe pain occurred for two weeks. He called at our emergency room because of a painful, necrolytic cutaneous ulcer over the scrotal region. A biopsy showed sterile dermal neutrophilia with lymphocytic vasculitis, and pyoderma gangrenosum was impressed. The patient received steroid treatment and recovery after one month.
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Affiliation(s)
- Deng-Ho Yang
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Taichung Armed-Forces General Hospital, Taichung 411, Taiwan.
- Department of Laboratory, Taichung Armed Forces General Hospital, Taichung 411, Taiwan.
- Department of Medical Laboratory Science and Biotechnology, Central Taiwan University of Science and Technology, Taichung 406, Taiwan.
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan.
| | - Meng-Yin Yang
- Department of Neurosurgery, Jan-Ai General Hospital, Taichung 412, Taiwan.
- Department of Neurosurgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan.
- College of Nursing, Central Taiwan University of Science and Technology, Taichung 406, Taiwan.
- Department of Neurosurgery, Taichung Veterans General Hospital, Taichung 407, Taiwan.
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7
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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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8
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Smith CR, Williams P. Sweet's syndrome in a patient with chronic lymphocytic leukaemia. BMJ Case Rep 2017; 2017:bcr-2017-220317. [PMID: 28784883 DOI: 10.1136/bcr-2017-220317] [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] [Indexed: 11/04/2022] Open
Abstract
Bullous Sweet's syndrome is a rare variant of the inflammatory neutrophilic dermatosis characterised by painful bullous skin lesions, fever, leukocytosis and a neutrophilic infiltrate of the dermis. The condition may be classified according to aetiology into classical (idiopathic), malignancy-associated and drug-induced. Neutrophilic infiltration occurs in response to a systemic insult. A punch biopsy for histology and culture is necessary due to its close resemblance to infection. Characteristic histology features a dense infiltration of neutrophils in the upper and mid dermis, oedema in the superficial dermis and endothelial swelling. Treatment with systemic glucocorticosteroids typically results in a dramatic clinical response. This case report illustrates a rare case of bullous Sweet syndrome associated with chronic lymphocytic leukaemia in a 53-year-old man.
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Affiliation(s)
| | - Penelope Williams
- Department of Dermatology, Royal Devon and Exeter Hospital, Exeter, Devon, UK
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9
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Sweet syndrome presenting as a febrile rash in a returning traveller. CAN J EMERG MED 2017; 20:476-478. [PMID: 28534449 DOI: 10.1017/cem.2017.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Sweet syndrome was discovered in 1964 and is now well described in the dermatology literature. Knowledge of this unique febrile and painful dermatosis is important for the emergency physician because the syndrome can be readily identified and is extremely responsive to oral steroid therapy. Early diagnosis can greatly improve patient satisfaction and avoid days of ineffective treatment. An accurate and timely diagnosis of Sweet syndrome is also important to guide investigation into a number of associated diseases.
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10
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Fong Y, Kauffmann RM, Marcinkowski E, Singh G, Schoellhammer HF. Dermatologic Emergencies. SURGICAL EMERGENCIES IN THE CANCER PATIENT 2017. [PMCID: PMC7122021 DOI: 10.1007/978-3-319-44025-5_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Yuman Fong
- Department of Surgery, City of Hope Medical Center, Duarte, California USA
| | | | - Emily Marcinkowski
- Surgical Oncology Hepatobiliary Surgery, City of Hope Medical Center, Duarte, California USA
| | - Gagandeep Singh
- Department of Surgery, City of Hope Medical Center, Durate, California USA
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11
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Cosgarea R, Senilă SC, Badea R, Ungureanu L. Pyoderma gangrenosum with spleen involvement. Review of the literature and case report. J Dermatol Case Rep 2016; 10:26-31. [PMID: 27900062 DOI: 10.3315/jdcr.2016.1230] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 09/04/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Pyoderma gangrenosum is a rare, ulcerative, destructive, non-infectious dermatologic disease and it is one clinical entity within the spectrum of neutrophilic dermatoses. Visceral involvement, manifesting as sterile neutrophilic infiltrates in sites other than skin and, is infrequent. Splenic involvement is very rare. MAIN OBSERVATIONS We present a case of a 58-year-old woman with pyoderma gangrenosum with spleen involvement and review all reports of similar cases.We have found nine reported cases, our case being the tenth. CONCLUSION Our review showed that spleen involvement in the course of pyoderma gangrenosum can occur at any age. It is slightly more frequent in men. An underlying or associated neutrophilic disorder is present in almost half of the patients. Skin manifestations were usually present before splenic involvement. In most cases the disese responds well to glucocorticosteroids.
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Affiliation(s)
- Rodica Cosgarea
- Iuliu Hațieganu University of Medicine and Pharmacy, Department of Dermatology, Cluj-Napoca, Romania
| | - Simona Corina Senilă
- Iuliu Hațieganu University of Medicine and Pharmacy, Department of Dermatology, Cluj-Napoca, Romania
| | - Radu Badea
- Ultrasonography Laboratory, Imaging and Radiology Department, "Octavian Fodor" Gastroenterology and Hepatology Regional Institute, Cluj-Napoca, Romania
| | - Loredana Ungureanu
- Iuliu Hațieganu University of Medicine and Pharmacy, Department of Dermatology, Cluj-Napoca, Romania
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12
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Anuset D, Reguiai Z, Perceau G, Colomb M, Durlach A, Bernard P. Caractéristiques cliniques et traitement du pyoderma gangrenosum dans la Marne. Ann Dermatol Venereol 2016; 143:108-17. [DOI: 10.1016/j.annder.2015.10.593] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 08/15/2015] [Accepted: 10/28/2015] [Indexed: 11/28/2022]
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13
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Hashemi SM, Fazeli SA, Vahedi A, Golabchifard R. Rituximab for refractory subcutaneous Sweet's syndrome in chronic lymphocytic leukemia: A case report. Mol Clin Oncol 2015; 4:436-440. [PMID: 26998300 DOI: 10.3892/mco.2015.715] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 11/27/2015] [Indexed: 01/04/2023] Open
Abstract
Sweet's syndrome is a neutrophilic dermatosis characterised by sudden onset of fever, neutrophilia, erythematous skin rashes and neutrophilic infiltration of the dermis. Subcutaneous Sweet's syndrome, or Sweet's panniculitis, is an uncommon variant of the classic syndrome, with hypodermal neutrophilic infiltration. The association of Sweet's syndrome with various malignancies has been reported. The most common underlying hematological malignancies are of myeloid origin; however, there have been several reports of the classic Sweet's syndrome in patients with a lymphoproliferative disorder, although the association of subcutaneous Sweet's syndrome with lymphoproliferative disorders has not been well-documented thus far. Herein, we present the case of a 48-year-old man with a 2-year history of chronic lymphocytic leukemia who developed fever and skin rashes, without any evidence of a relapse. The clinical and pathological investigation resulted in the diagnosis of subcutaneous Sweet's syndrome. The patient exhibited no significant response to conventional therapeutic measures; however, following two subsequent doses of rituximab, his general condition and skin rash improved. The follow-up skin biopsy demonstrated dermal neutrophilic infiltrations in conjunction with prior mixed lobular and septal panniculitis, suggesting evolution of subcutaneous Sweet's syndrome to its classic form. To the best of our knowledge, this is one of the first reports of rituximab as a novel biological treatment for Sweet's syndrome. However, further randomized trials are required to evaluate the efficacy and safety of such biological therapies for Sweet's syndrome.
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Affiliation(s)
- Seyed Mehdi Hashemi
- Division of Hematology and Medical Oncology, Department of Internal Medicine, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran; Division of Hematology and Medical Oncology, Department of Internal Medicine, Ali-Ebne-Abitaleb Hospital, Zahedan, Iran
| | - Seyed Amirhossein Fazeli
- Department of Internal Medicine, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Abdolbaset Vahedi
- Students' Scientific Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Reza Golabchifard
- Department of Internal Medicine, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
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14
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Pyoderma gangrenosum with monoclonal IgA gammopathy and pulmonary tuberculosis. Illustrative case and review. Postepy Dermatol Alergol 2015; 32:137-41. [PMID: 26015785 PMCID: PMC4436233 DOI: 10.5114/pdia.2014.40974] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 01/06/2014] [Accepted: 01/13/2014] [Indexed: 02/07/2023] Open
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15
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Gade M, Studstrup F, Andersen AK, Hilberg O, Fogh C, Bendstrup E. Pulmonary manifestations of pyoderma gangrenosum: 2 cases and a review of the literature. Respir Med 2015; 109:443-50. [PMID: 25622759 DOI: 10.1016/j.rmed.2014.12.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 12/25/2014] [Accepted: 12/29/2014] [Indexed: 11/28/2022]
Abstract
Pyoderma gangrenosum (PG) is a rare ulcerative neutrophilic dermatologic disease that occasionally is accompanied by extracutaneous manifestations, amongst these is pulmonary involvement. The etiology is unknown. More than 50% of PG cases are associated with an underlying systemic disease such as inflammatory bowel disease, rheumatoid arthritis, hematological disorder or malignancy. Extracutaneous manifestations are rare and only 29 cases of pulmonary involvement have been reported previously in the literature. Pyoderma gangrenosum is usually diagnosed in the third to sixth decade, but early debut in childhood is also described. Skin manifestations are usually evident before pulmonary involvement, although primary lung affection is seen. Pulmonary involvement is diagnosed simultaneously or from a few weeks up to several years after the diagnosis of cutaneous PG. The most important differential diagnoses are lung cancer, lung abscess and Wegener's granulomatosis. Histological specimens will exclude these diagnoses. The treatment of PG is immune modulation, but due to the rarity of the disease, only one randomized treatment trials exists [1] and the long term course of PG with pulmonary involvement is unknown. We present two cases of pulmonary manifestations of pyoderma gangrenosum and a review of the literature.
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Affiliation(s)
- Melina Gade
- Department of Respiratory Medicine and Allergology, Aarhus University Hospital, Denmark.
| | - Frej Studstrup
- Department of Dermatology, Aarhus University Hospital, Denmark
| | | | - Ole Hilberg
- Department of Respiratory Medicine and Allergology, Aarhus University Hospital, Denmark
| | - Carsten Fogh
- Department of Dermatology, Aarhus University Hospital, Denmark
| | - Elisabeth Bendstrup
- Department of Respiratory Medicine and Allergology, Aarhus University Hospital, Denmark
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16
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Kapila S, Reid I, Dixit S, Fulcher G, March L, Jackson C, Cooper A. Use of dermal injection of activated protein C for treatment of large chronic wounds secondary to pyoderma gangrenosum. Clin Exp Dermatol 2014; 39:785-90. [PMID: 25155809 DOI: 10.1111/ced.12361] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pyoderma gangrenosum (PG) is a systemic disease that presents with cutaneous necrotizing ulceration, producing deep necrotic ulcers, usually with a raised, undermined, violaceous border. Treatment typically involves high dose immunosuppressive drugs, but more recently anti-tumour necrosis factor and monoclonal antibodies have been used. Activated protein C (APC) stimulates wound healing in patients with treatment-refractory skin ulcers, possibly by stimulating angiogenesis and re-epithelialization, and preventing inflammation. AIM To investigate whether APC may be beneficial as a treatment for ulcers related to cutaneous PG. METHODS Two patients were recruited with a clinical history and physical and histopathological evidence of acute PG. A total of 400 μg (1.0 mL) of APC was injected subcutaneously into the dermal edge of necrotic PG ulcers weekly for a total treatment period of 6 weeks. Photographs were taken, and clinical progress, ulcer size and pain score were monitored during this period and after the cessation of treatment, at weeks 8 and 12. RESULTS Over the 12 weeks of the trial, APC led to a reduction in wound size from 3.8 cm(2) to 0.8 cm(2) in patient 1 (78.9% decrease) and from 41 cm(2) to 16 cm(2) in patient 2 (70.0% decrease, respectively), and a reduction in pain scores from 10 to 0 (100% decrease) in both patients. CONCLUSION Although this study has limited because of its small sample size and lack of a true placebo group, it does indicate that APC has potential as a therapeutic option for patients with chronic skin ulcers from PG.
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Affiliation(s)
- S Kapila
- Department of Dermatology, Kolling Institute of Medical Research, University of Sydney Royal North Shore Hospital, St Leonards, NSW, Australia
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17
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Abstract
Sweet's syndrome, a neutrophilic dermatosis, is a known paraneoplastic complication occurring with various malignancies. It has been infrequently reported in association with melanoma. Ipilimumab is an antibody against an inhibitory cytotoxic T-lymphocyte-associated antigen 4 receptor on T cells. It is associated with a range of immune-related toxicities. Sweet's syndrome in association with ipilimumab has been reported only briefly in the literature. However, neutrophilic infiltration has been seen in biopsies of patients with ipilimumab-associated enterocolitis. We report, in detail, the case of a woman with metastatic melanoma undergoing ipilimumab therapy. After the second cycle of immunotherapy, the patient presented with high-grade fever followed by a rash on her hands. No infectious etiology was elucidated after an extensive workup. Pathologic examination of the skin biopsy from the hands confirmed neutrophilic dermatosis. The patient was treated with systemic steroids achieving complete remission of the skin lesions. Physicians should be aware of Sweet's syndrome as a possible cutaneous side effect of ipilimumab therapy and be familiar with its management.
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18
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Saffie M, Sun D, Hsia C. Sweet's syndrome in chronic myelomonocytic leukemia. Am J Hematol 2013; 88:630. [PMID: 23417993 DOI: 10.1002/ajh.23415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Revised: 02/05/2013] [Accepted: 02/09/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Muntasir Saffie
- London Health Sciences Centre; Medicine, Division of General Medicine; East London Ontario Canada N6A 5W9
| | - Dongmei Sun
- London Health Sciences Centre; Medicine, Division of General Medicine; East London Ontario Canada N6A 5W9
| | - Cyrus Hsia
- London Health Sciences Centre; Medicine, Division of Hematology, Victoria Hospital; East London Ontario Canada N6A 5W9
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19
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Abstract
Parastomal pyoderma gangrenosum (PPG) is an unusual neutrophilic dermatosis characterized by painful, necrotic ulcerations occurring in the area surrounding an abdominal stoma. It typically affects young to middle-aged adults, with a slight female predominance. The underlying etiology for PPG remains enigmatic but aberrant immune response to injury may play a pivotal role. The reported risk factors for the development of PPG include the presence of extra-intestinal manifestations, autoimmune disorders and obesity, along with local factors, such as the presence of parastomal hernia or pressure ulcer. PPG can develop at any time after the stoma construction. The histopathological features of PPG are not pathognomonic and its diagnosis is mainly based on clinical features. The management of PPG often requires a multidisciplinary approach, with a combination of local wound care and systemic medications.
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Affiliation(s)
- Xian-Rui Wu
- Department of Colorectal Surgery, the Cleveland Clinic Foundation,Cleveland, Ohio, USA and Department of Gastroenterology/Hepatology, the Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Valois A, Cuvelier C, Roux X, Cabon M, Cinquetti G, Carassou P, Védy S, Dorvaux V, Puyhardy JM, Graffin B, Schmidt J. [Fever, weight loss and arthralgia in a 52-year-old woman]. Rev Med Interne 2013; 34:247-9. [PMID: 23419859 DOI: 10.1016/j.revmed.2012.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 07/06/2012] [Indexed: 11/28/2022]
Affiliation(s)
- A Valois
- Service de médecine interne, hôpital d'instruction des armées Legouest, 27, avenue de Plantières, BP 90001, 57077 Metz cedex 3, France
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21
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Choe H, Sakano H, Takigami H, Inaba Y, Matsuo K, Saito T. Pyoderma gangrenosum with wrist joint destruction: case report. J Hand Surg Am 2013; 38:357-61. [PMID: 23267758 DOI: 10.1016/j.jhsa.2012.10.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 10/29/2012] [Accepted: 10/30/2012] [Indexed: 02/02/2023]
Abstract
Pyoderma gangrenosum (PG) is a rare, noninfectious, neurotrophic dermatosis. We observed a case of PG mimicking cutaneous and osteoarticular infections that presented with a prolonged ulcer on the forearm, severe wrist pain, anemia, substantial local and systemic inflammation as evaluated by serum laboratory data, and carpal osteolysis. Although PG rarely damages joints, the ulcer extended to the joint and destroyed the osteochondral tissues. Advanced ulcerative colitis, which is a most common comorbidity of PG, proved to be an underlying disease. Antibiotic and surgical treatment did not heal the ulcer, which was successfully treated with corticosteroids. This intractable ulcer is often misdiagnosed. Hence when a patient presents with an enlarged, painful, unusual skin lesion, PG should always be considered.
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Affiliation(s)
- Hyonmin Choe
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama, Japan.
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22
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Ma EH, Akikusa JD, MacGregor D, Ng J, Su JC. Sweet's syndrome with postinflammatory elastolysis and Takayasu arteritis in a child: a case report and literature review. Pediatr Dermatol 2012; 29:645-50. [PMID: 22011145 DOI: 10.1111/j.1525-1470.2011.01597.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Sweet's syndrome (SS) is an uncommon condition characterized by recurrent painful cutaneous inflammatory eruptions. It is rare in childhood and has a broad range of extracutaneous manifestations. We describe a child presenting with SS and postinflammatory elastolysis who subsequently developed aortitis complicated by aortic dilatation requiring surgical intervention. Histologic features of the aorta were consistent with Takayasu arteritis (TA). Our case and previously reported cases of pediatric SS complicated by aortitis all demonstrate striking clinical similarities in that all have been associated with postinflammatory elastolysis of involved skin and aneurysmal dilation of the thoracic aorta. We propose that TA should be considered one of the disease associations of SS when complicated by postinflammatory elastolysis and that early referral for cardiovascular screening be considered in this group of patients.
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Affiliation(s)
- Ellen H Ma
- Department of Dermatology, Royal Children's Hospital, Melbourne, Australia
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23
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Fraccalvieri M, Fierro MT, Salomone M, Fava P, Zingarelli EM, Cavaliere G, Bernengo MG, Bruschi S. Gauze-based negative pressure wound therapy: a valid method to manage pyoderma gangrenosum. Int Wound J 2012; 11:164-8. [PMID: 22891652 DOI: 10.1111/j.1742-481x.2012.01058.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Pyoderma gangrenosum (PG) is an uncommon ulcerative, non-infective chronic inflammatory skin disorder of unknown aetiology. Systemic therapies are necessary to control the associated medical diseases, and, due to the inflammatory nature of PG, topical or systemic immunosuppressant agents are effective, but wound healing is usually slow. Negative wound pressure therapy (NPWT) has become an important tool for the management of complex skin ulcers, and usage in PG has been recently described in the literature: we present four cases of classic PG in which NPWT in association with systemic therapy achieved wound healing and a drastic pain reduction.
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Affiliation(s)
- Marco Fraccalvieri
- Plastic Surgery Department, University of Turin, San Giovanni Battista di Torino, Via Cherasco 23, Turin, ItalyDepartment of Biomedical Sciences and Human Oncology, Section of Dermatology, University of Turin, San Giovanni Battista di Torino, Via Cherasco 23, Turin, Italy
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Can snus (Swedish moist snuff) be used as a treatment of Pyoderma gangrenosum? Med Hypotheses 2012; 78:619-20. [DOI: 10.1016/j.mehy.2012.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 01/23/2012] [Indexed: 11/19/2022]
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Ndahi AA, Tahir C, Nggada HA. Photoletter to the editor: Scarring alopecia resulting from pyoderma gangrenosum of the scalp. J Dermatol Case Rep 2012; 6:34-5. [PMID: 22514589 DOI: 10.3315/jdcr.2012.1093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 07/25/2011] [Indexed: 11/11/2022]
Abstract
Pyoderma gangrenosum is an uncommon ulcerative cutaneous condition of uncertain aetiology. It is a disease that causes tissue to become necrotic, leading to deep ulcers. We report a case of pyoderma gangrenosum localized at the scalp, which is an unusual location. After 16 months of treatment with prednisolone 40 mg daily, methotrexate 15 mg weekly, ciprofloxacin 500 mg and honey dressing the indurated elevated ulcer margins flattened and the ulcer healed with scarring of the entire scalp.
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Affiliation(s)
- Akilahyel A Ndahi
- Department of Medicine, University of Maiduguri Teaching Hospital, P.M.B, 1414, Bema Road, Maiduguri, Borno State, Nigeria
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Infections in Leukemia and Hematopoietic Stem Cell Transplantation. LEUKEMIA AND RELATED DISORDERS 2012. [PMCID: PMC7178857 DOI: 10.1007/978-1-60761-565-1_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Infections are one of the most common complications in patients diagnosed with leukemia and serve as a major obstacle to treatment. Through the early 1970s, infections were the most common cause of death in patients diagnosed with acute leukemia, but improvement in treatment and supportive care over the past few decades, coupled with expanded prophylaxis and prevention regimens, have led to reduction in both the frequency and severity of infections. Regardless, due in part to an aging cancer population and the diversity of cancer treatments and procedures, infectious diseases remain a major cause of morbidity and mortality in patients with leukemia.
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