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Glennon CM, Tan AJ, Prabhu M, Kroshinsky D. Sweet syndrome in pregnancy: A narrative review. Int J Gynaecol Obstet 2024; 166:538-550. [PMID: 38881204 DOI: 10.1002/ijgo.15713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/18/2024] [Indexed: 06/18/2024]
Abstract
The aim of this review is to increase obstetrician awareness of pregnancy-associated Sweet syndrome. Patients present with fever, leukocytosis, and skin eruption, which can mimic other infectious or inflammatory conditions, but do not respond to antibiotics. A search using PubMed, EMBASE, and Web of Science Core Collection was conducted to review all reported cases of pregnancy-associated Sweet syndrome, an acute febrile neutrophilic dermatosis occurring during pregnancy or postpartum. A total of 33 episodes among 30 patients were identified, with the majority (54.5% [18]) of cases occurring within the second trimester. Among the 30 patients, skin lesions most commonly affected the head and neck (73.3% [22]), with rare oral or ocular involvement. Leukocytosis was the most common laboratory finding, reported in 96.7% [29] of patients, with neutrophil predominance noted in 70.0% [21]. The diagnosis was confirmed for all patients with pathognomonic results of skin biopsies. Of the 27 cases detailing treatment, systemic corticosteroids were most frequently used (19 cases), followed by conservative management (seven cases), and dapsone (one case). The dapsone-treated patient and 15 of the 19 steroid-treated patients experienced resolution, but additional management strategies were required in the remaining four individuals. Spontaneous resolution occurred during pregnancy in six of the seven conservatively managed individuals, with one patient experiencing spontaneous abortion shortly after skin eruption at 10 weeks of gestation. No associated maternal deaths were reported. Obstetric complications of pregnancy-associated Sweet syndrome included endomyometritis, sterile placental abscesses, and abdominal wall necrosis. Delivery of healthy infants occurred in 24 of the 25 cases that presented fetal outcome, which included two infants who underwent medically indicated preterm deliveries.
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Affiliation(s)
- Colleen M Glennon
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Alice J Tan
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Malavika Prabhu
- Department of Obstetrics and Gynecology, Maternal-Fetal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniela Kroshinsky
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina, USA
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2
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Hrin ML, Huang WW. Sweet Syndrome and Neutrophilic Dermatosis of the Dorsal Hands. Dermatol Clin 2024; 42:193-207. [PMID: 38423681 DOI: 10.1016/j.det.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Sweet syndrome is a rare cutaneous condition with a broad clinical differential diagnosis. It can be classified into 3 subtypes: classic, malignancy-associated, and drug-induced. There are numerous associated disorders and provoking medications. Uncommonly, it can present as a multiorgan disease and cause significant morbidity. Systemic corticosteroids are the gold standard of treatment and yield rapid improvements in both lesions and symptoms. Nonsteroidal therapies may be effective alternatives, although high-quality comparative data are lacking. Some treatments for Sweet syndrome have paradoxically been implicated in the induction of disease.
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Affiliation(s)
- Matthew L Hrin
- Department of Dermatology, Wake Forest School of Medicine, Medical Center Boulevard, 4618 Country Club Road, Winston-Salem, NC 27157-1071, USA.
| | - William W Huang
- Department of Dermatology, Wake Forest School of Medicine, 4618 Country Club Road, Winston-Salem, NC 27104, USA
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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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Gil-Lianes J, Luque-Luna M, Alamon-Reig F, Bosch-Amate X, Serra-Garcia L, Mascaró JM. Sweet Syndrome: Clinical Presentation, Malignancy Association, Autoinflammatory Disorders and Treatment Response in a Cohort of 93 Patients with Long-term Follow-up. Acta Derm Venereol 2023; 103:adv18284. [PMID: 38112209 PMCID: PMC10753595 DOI: 10.2340/actadv.v103.18284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/03/2023] [Indexed: 12/21/2023] Open
Abstract
Sweet syndrome is a neutrophilic dermatosis associated with multiple disorders. This retrospective case-series study of patients with Sweet syndrome in a tertiary hospital in Spain from 2001 to 2021, explores clinicopathological characteristics of Sweet syndrome and variables associated with malignancy, presence of autoinflammatory disorders and differences between histological subtypes. A total of 93 patients were identified: 30% idiopathic, 34% malignancy-associated, 29% reactive to infections or drug-associated, and 6% with an autoimmune/inflammatory condition. Acute myeloid leukaemia was the most common malignancy (16/93) followed by myelodysplastic syndrome (7/93). Patients with acute myeloid leukaemia presented isolated flares, marked cytopaenia and rapid response to treatment, whereas myelodysplastic syndrome followed a chronic-recurrent course. The most frequent associated medications and inflammatory disorders were filgrastim and hydroxyurea (n = 2); and inflammatory bowel disease (n = 4). In addition, 3 patients were diagnosed with VEXAS syndrome. Male sex (p = 0.006), fever (p = 0.034), increased erythrocyte sedimentation rate (p < 0.001), anaemia (p < 0.001), and thrombocytopaenia (p < 0.001) were associated with malignancy. Histologically, patients were classified as classic (60%), histiocytoid (22.5%) or subcutaneous (15%), with pain (p = 0.011) and nodules (p < 0.001) being associated with subcutaneous-Sweet syndrome. Sweet syndrome in the context of cytopaenia should alert the presence of malignancy. An acquired autoinflammatory condition should be explored in relapsing Sweet syndrome with myelodysplastic syndrome. A minimum follow-up of 6 months is recommended.
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Affiliation(s)
- Javier Gil-Lianes
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain
| | - Mar Luque-Luna
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain
| | - Francesc Alamon-Reig
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain
| | - Xavier Bosch-Amate
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain
| | - Laura Serra-Garcia
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain
| | - José M Mascaró
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain.
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Nazaretyan S, Ali A, Yaghmour G, Tong A, Castillo V, Rodrigues S, Ladha A, Woan K, Tam E, Shi SY, Bateshansky D, Chaudhary PM. Unique challenges to diagnosing sweet syndrome following induction chemotherapy for relapsed Acute Myeloid Leukemia (AML): A case and brief-review. Respir Med Case Rep 2023; 46:101922. [PMID: 37841284 PMCID: PMC10570145 DOI: 10.1016/j.rmcr.2023.101922] [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: 06/16/2023] [Revised: 09/04/2023] [Accepted: 09/29/2023] [Indexed: 10/17/2023] Open
Abstract
Background Sweet Syndrome (SS) is a rare inflammatory skin condition characterized by the sudden appearance of tender, erythematous or violaceous papules, plaques, and nodules typically found on the face, neck, shoulder, upper extremities, and trunk. Often, SS is difficult to diagnose because of its various non-specific manifestations, including fever, arthralgia, myalgia and ocular involvement. In most cases described in literature, cutaneous and pulmonary symptoms of SS present in a concomitant manner. Several reported cases of pulmonary SS have shown that if left untreated, acute respiratory distress syndrome can ensue and progress to fatal respiratory failure. Case report A 58-year-old female with acute myeloid leukemia (AML) secondary to chronic lymphocytic leukemia (CLL) presented with new nodular lesions, dyspnea, and fevers. Chest X-ray revealed pulmonary infiltrates. The patient developed new facial lesions and worsening hypoxic respiratory failure. Further infectious workup was negative. She was found to have SS with pulmonary involvement and initiated on high-dose intravenous (IV) steroids with marked clinical improvement. Conclusions Major and minor criteria for the diagnosis of lung-associated SS should be carefully evaluated, especially when a biopsy is unavailable. The following case report describes the clinical course and outcomes from treatment for this patient.
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Affiliation(s)
- Samvel Nazaretyan
- University of Southern California, Keck School of Medicine, LA, USA
- Nohl Division of Hematology and Center for the Study of Blood Diseases, Department of Medicine, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Amir Ali
- University of Southern California, Keck School of Medicine, LA, USA
- Nohl Division of Hematology and Center for the Study of Blood Diseases, Department of Medicine, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - George Yaghmour
- University of Southern California, Keck School of Medicine, LA, USA
- Nohl Division of Hematology and Center for the Study of Blood Diseases, Department of Medicine, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Anhthy Tong
- University of Southern California, Keck School of Medicine, LA, USA
- Nohl Division of Hematology and Center for the Study of Blood Diseases, Department of Medicine, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Vanessa Castillo
- University of Southern California, Keck School of Medicine, LA, USA
- Nohl Division of Hematology and Center for the Study of Blood Diseases, Department of Medicine, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Sonia Rodrigues
- University of Southern California, Keck School of Medicine, LA, USA
- Nohl Division of Hematology and Center for the Study of Blood Diseases, Department of Medicine, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Abdullah Ladha
- University of Southern California, Keck School of Medicine, LA, USA
- Nohl Division of Hematology and Center for the Study of Blood Diseases, Department of Medicine, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Karrune Woan
- University of Southern California, Keck School of Medicine, LA, USA
- Nohl Division of Hematology and Center for the Study of Blood Diseases, Department of Medicine, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Eric Tam
- University of Southern California, Keck School of Medicine, LA, USA
- Nohl Division of Hematology and Center for the Study of Blood Diseases, Department of Medicine, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Samantha Y. Shi
- University of Southern California, Keck School of Medicine, LA, USA
- Nohl Division of Hematology and Center for the Study of Blood Diseases, Department of Medicine, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - David Bateshansky
- University of Southern California, Keck School of Medicine, LA, USA
- Nohl Division of Hematology and Center for the Study of Blood Diseases, Department of Medicine, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Preet M. Chaudhary
- University of Southern California, Keck School of Medicine, LA, USA
- Nohl Division of Hematology and Center for the Study of Blood Diseases, Department of Medicine, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
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Agrawal A, Arif SH, Kumarasan K, Janjua D. Sweet's Syndrome: An Update. Curr Pediatr Rev 2022; 18:265-273. [PMID: 35209834 DOI: 10.2174/1573396318666220223100208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/20/2021] [Accepted: 12/29/2021] [Indexed: 11/22/2022]
Abstract
Sweet's syndrome is a serious dermatological disorder characterized by a rapid onset of tender plaques or nodules, fever, joint pain, headache, and oral and genital lesions. According to the clinical features and underlying causes, Sweet's syndrome is divided into three categories, i.e., classical (or idiopathic), malignancy-associated Sweet's syndrome, and drug-induced Sweet's syndrome. It is multifactorial in etiology, and the exact cause is still undetermined. The diagnosis can be confirmed by the routine histopathologic evaluation of skin biopsy from the lesions. The first-line treatment options are topical and systemic steroids. Multiple databases, like Medline/PubMed, Scopus, and Google, were used to identify resources for this literature review. The relevant information was collected from various case reports, case series, reviews, meta-analyses, and large clinical trials reporting clinical description, etiology, diagnosis, and management of Sweet's syndrome. This narrative review aimed to discuss recent understandings related to Sweet's syndrome, both in terms of clinical presentation and management approach.
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Affiliation(s)
- Amit Agrawal
- Department of Pediatrics, Gandhi Medical College, Bhopal, MP, India
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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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Paul S, Jammal N, Akhave N, Aung PP, Loghavi S, Jain N, Garcia-Manero G, Borthakur G, Verstovsek S, Jabbour E, Adachi J, Masarova L, Daver N, Ravandi F, Pemmaraju N. Atypical cases of necrotizing sweet syndrome in patients with myelodysplastic syndrome and acute myeloid leukaemia. Br J Haematol 2020; 191:e10-e13. [PMID: 32686139 DOI: 10.1111/bjh.16937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Shilpa Paul
- Departments of Clinical Pharmacy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nadya Jammal
- Departments of Clinical Pharmacy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Neal Akhave
- Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Phyu P Aung
- Dermatopathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sanam Loghavi
- Hematopathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nitin Jain
- Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Gautam Borthakur
- Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Srdan Verstovsek
- Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elias Jabbour
- Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Javier Adachi
- Infectious Disease, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lucia Masarova
- Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Naval Daver
- Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Farhad Ravandi
- Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Naveen Pemmaraju
- Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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9
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Dan H, Yanmei L, Yue X, Xian J. Sweet syndrome associated with malignancies: A retrospective analysis of 25 patients from West China hospital. Dermatol Ther 2020; 33:e13588. [PMID: 32410345 DOI: 10.1111/dth.13588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/12/2020] [Indexed: 02/05/2023]
Abstract
Sweet syndrome (SS), also known as acute febrile neutrophilic dermatosis, is a rare inflammatory disorder characterized by sudden onset of variably tender brightly erythematous-to-violaceous papules, plaques, or nodules. To clarify the frequency, clinical course, therapeutic response, and outcome of Sweet syndrome with malignancy. We conducted a retrospective review of patients diagnosed with SS between 2009 and 2019 with a diagnosis of Sweet syndrome in West China hospital. Records were analyzed for variables, clinical features, etiological factors, laboratory results, and treatment outcomes. The 25 cases under study consisted of 14 (56%) females and 11 (44%) males. Mean age was 52.2 years (range: 4-76 years). Nodules were the commonest lesion presentation (48%), involving mostly the lower limbs (52%). Pain of lesion was identified as the most common symptom (88%), followed by fever (76%) and cough (44%). Among the patients, 52% exhibited the classic form, 48% showed the malignancy-associated form, and 4% exhibited the drug-induced form in the setting of malignancy. Acute myeloid leukemia was the most common malignancy, observed in 5 of 12 patients (41.6%). Anemia (P = .002) was associated with malignancy (Chi-square test).
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Affiliation(s)
- Hao Dan
- Department of Dermatology and Venereology, West China Hospital, SiChuan University, SiChuan, P.R. China
| | - Li Yanmei
- Department of Dermatology and Venereology, West China Hospital, SiChuan University, SiChuan, P.R. China
| | - Xiao Yue
- Department of Dermatology and Venereology, West China Hospital, SiChuan University, SiChuan, P.R. China
| | - Jiang Xian
- Department of Dermatology and Venereology, West China Hospital, SiChuan University, SiChuan, P.R. China
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Abstract
Inflammatory bowel disease (IBD) is a chronic immune-mediated inflammatory condition primarily involving the gastrointestinal tract. It includes Crohn's disease (CD), ulcerative colitis (UC), and a less common phenotype-indeterminate colitis. It is thought to result from a complex interplay of environmental, microbial, and host factors including genetic factors, although the exact mechanism is not known. Dietary factors have been shown to play a role in the pathogenesis of IBD and can potentially alter the intestinal microbiota as well as disrupt the immune function in the gut. CD is characterized by transmural inflammation, sometimes associated with granulomatous lesions, and involves the entire gastrointestinal tract but often spares the rectum. UC is characterized by mucosal inflammation typically confined to the colon and rectum. Although IBD is mostly seen in western world, recent data suggests that the incidence and prevalence are increasing worldwide. Enteral nutrition has been shown to be effective in inducing remission in pediatric population with CD; however, there is mixed data in adult population. Nutritional deficiencies such as vitamin D and zinc deficiency are often noted in IBD patients. Several extraintestinal manifestations are noted in patients with IBD. Some of them parallel with the disease activity and others are independent of the disease course. Assessment of IBD disease activity clinically, radiologically, if indicated, biochemically and endoscopically is important to guide therapy in IBD. To ensure comprehensive care, it is important to assess associated conditions such as nutritional and psychological well-being, as well as age appropriate health maintenance status prior to starting treatment for IBD. Several biologic agents including anti-tumor necrosis factor alpha (anti-TNF-α) drugs, anti-integrins, and antibodies to the p40 subunit of IL12/23 are approved for induction and maintenance of remission of IBD. Steroids are also often used for induction. Anti-metabolites and thiopurines are also useful either as monotherapy or in combination regimens. Potential side effects of anti-TNF-α drugs such as serious infections, malignancy, worsening of heart failure, and infusion-related reactions should be considered prior to starting these drugs. Anti-TNF-α drugs with or without immunomodulators (azathioprine, 6-mercaptopurine, methotrexate) are often used for the induction and maintenance of remission. Treating to target of endoscopic and clinical remission provides the best long-term outcomes. Our knowledge and understanding of IBD has grown significantly. However, there are several unanswered questions on pathogenesis, disease behavior, and drivers of inflammation in various patient subgroups which require further research.
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Zheng S, Li S, Tang S, Pan Y, Ding Y, Qiao J, Fang H. Insights Into the Characteristics of Sweet Syndrome in Patients With and Without Hematologic Malignancy. Front Med (Lausanne) 2020; 7:20. [PMID: 32133363 PMCID: PMC7039821 DOI: 10.3389/fmed.2020.00020] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/14/2020] [Indexed: 12/20/2022] Open
Abstract
Background: Sweet syndrome is a neutrophilic dermatosis that could be associated with malignancy, especially hematologic malignancy. Few studies have systematically elaborated on this disorder and its features related with hematologic malignancy. Objective: This study aimed to describe the clinicopathological characteristics, treatment, and outcome of Sweet syndrome and to evaluate patient characteristics associated with hematologic malignancy. Methods: We retrospectively reviewed patients with Sweet syndrome at the Department of Dermatology, the First Affiliated Hospital of Zhejiang University from October 2010 to February 2019. Results: The study included 37 patients (16 men and 21 women), with a mean age of 53 years. Ten patients (27%) were classified as having malignancy-associated Sweet syndrome: nine with a hematologic malignancy including acute myeloid leukemia (4/9, 44%), myelodysplastic syndrome (4/9, 44%), and multiple myeloma (1/9, 11%) and one with a solid tumor diagnosed with liver carcinoma. The mean hemoglobin and platelet levels (P = 0.007 and P = 0.013, respectively), were significantly lower in patients with hematologic malignancy than in those with Sweet syndrome only. No significant difference in histopathology was found between patients with and without hematologic malignancy. Systemic corticosteroids were the most frequently used treatment (24/37, 65%). Higher mortality was found in patients with hematologic malignancy. Conclusion: It is important to assess Sweet syndrome patients who have laboratory evidence of lower hemoglobin and platelet levels for a hematologic malignancy.
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Affiliation(s)
- Siting Zheng
- Department of Dermatology, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Sheng Li
- Department of Dermatology, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Shunli Tang
- Department of Dermatology, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Yunlei Pan
- Department of Dermatology, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Yuwei Ding
- Department of Dermatology, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Jianjun Qiao
- Department of Dermatology, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Hong Fang
- Department of Dermatology, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
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12
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Ahangari D, Ngendahayo P, Colinet B, Roquet-Gravy PP. [A case of Sweet syndrome in a patient receiving erlotinib for lung adenocarcinoma]. Ann Dermatol Venereol 2020; 147:202-206. [PMID: 32029299 DOI: 10.1016/j.annder.2019.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 01/18/2019] [Accepted: 10/25/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Sweet syndrome is a neutrophilic dermatosis and is often idiopathic, although its onset may be drug-induced or paraneoplastic. The purpose of this case report is to describe the very first occurrence of Sweet syndrome following erlotinib intake in a patient diagnosed with lung adenocarcinoma. PATIENTS AND METHODS We observed Sweet syndrome, as assessed by clinical, laboratory and histological examination, in a middle-aged female patient presenting lung adenocarcinoma diagnosed three years prior to her cutaneous symptoms. DISCUSSION Given the extremely long time between the diagnosis of lung cancer and the onset of Sweet syndrome, as well as the occurrence of skin lesions during administration of the medication and their subsidence after drug withdrawal, we suggest a possible link between this particular EGFR tyrosine kinase inhibitor and the patient's neutrophilic dermatological signs. To our knowledge this association has not previously been described in the medical literature.
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Affiliation(s)
- D Ahangari
- Service de dermatologie, grand hôpital de Charleroi (GHDC), Charleroi, Belgique; Rue de Villers, 1, 6280 Loverval, Belgique.
| | - P Ngendahayo
- Service d'anatomopathologie, Institut de pathologie et génétique (IPG), avenue Georges-Lemaitre, 25, 6041 Charleroi, Belgique
| | - B Colinet
- Service de pneumologie, grand hôpital de Charleroi (GHDC), Grand'rue 3, 6000 Charleroi, Belgique
| | - P-P Roquet-Gravy
- Service de dermatologie, grand hôpital de Charleroi (GHDC), Charleroi, Belgique; Rue de Villers, 1, 6280 Loverval, Belgique
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13
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Keller JJ, Fett NM, Morrison LH. Dermatology in the Diagnosis of Noncutaneous Malignancy. Dermatol Clin 2019; 37:537-544. [DOI: 10.1016/j.det.2019.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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14
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Siedlikowski ST, Lacroix JD. Sweet's syndrome and fistulizing Crohn's disease: A case report. SAGE Open Med Case Rep 2019; 7:2050313X19850968. [PMID: 31210935 PMCID: PMC6552338 DOI: 10.1177/2050313x19850968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Sweet's syndrome is a rare, acute febrile neutrophilic dermatosis sometimes associated with inflammatory diseases, infections, malignancies or the administration of pharmacotherapeutics. Very seldom, it occurs as an extraintestinal manifestation of Crohn's disease. We present a unique combined diagnosis of recurrent Sweet's syndrome associated with colovaginal fistulization, subsequently diagnosed as Crohn's disease.
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Affiliation(s)
| | - Julie D Lacroix
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Division of Dermatology, Montfort Hospital, Ottawa, ON, Canada.,Dermatology Clinic, Bruyère Continuing Care, Ottawa, ON, Canada
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15
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Lepelletier C, Bouaziz JD, Rybojad M, Bagot M, Georgin-Lavialle S, Vignon-Pennamen MD. Neutrophilic Dermatoses Associated with Myeloid Malignancies. Am J Clin Dermatol 2019; 20:325-333. [PMID: 30632096 DOI: 10.1007/s40257-018-00418-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Neutrophilic dermatoses (ND) are a group of conditions characterized by an aseptic accumulation of polymorphonuclear leukocytes in the skin. Occurrence of ND in association with myeloid malignancies, mainly myelodysplastic syndrome and myelogenous acute leukemia, is not rare and is often associated with a poor prognosis. Recent findings have improved understanding of the pathophysiology of myeloid malignancy-associated ND. We review the clinical spectrum of myeloid malignancy-associated ND with an emphasis on recently identified mechanisms. Myeloid leukemia cells retain the potential for terminal differentiation into polymorphonuclear leukocytes in the skin. Many studies suggest a clonal link between myeloid malignancies and ND. Activation of autoinflammatory pathways (NOD-like receptor family pyrin domain-containing-3, Familial Mediterranean Fever Gene) in the clonal cells of myeloid disorders may also be involved in this setting.
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16
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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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17
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Kleinert S, La Rosée P, Krüger K. [Rheumatoid symptoms in patients with hematologic neoplasms]. Z Rheumatol 2018; 76:38-45. [PMID: 29330756 DOI: 10.1007/s00393-017-0338-9] [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: 10/18/2022]
Abstract
Paraneoplastic syndromes in lymphatic or myeloid neoplasms can present with musculoskeletal symptoms, vasculitis-like or febrile symptoms. Hematologic diseases are also associated with rheumatic diseases whereas inflammatory rheumatic diseases are often associated with an increased risk for lymphoproliferative disease. Atypical disease characteristics, lack of disease-specific antibodies or therapeutic response are red flags for diagnosing paraneoplastic or coexistent malignant diseases. New onset of systemic symptoms, worsening of general condition, night sweats or weight loss need to be considered during follow-up and differential diagnostics. This article focuses on musculoskeletal, vasculitis-like and systemic signs of lymphatic or myeloid neoplasms either because of coexistency, tumor association or paraneoplastic disease.
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Affiliation(s)
- S Kleinert
- Rheumatologische Schwerpunktpraxis, Praxisgemeinschaft Rheumatologie - Nephrologie, Möhrendorfer Str. 1c, 91056, Erlangen, Deutschland.
| | - P La Rosée
- Klinik für Innere Medizin II, Onkologie, Hämatologie, Immunologie, Infektiologie und Palliativmedizin, Schwarzwald-Baar-Klinikum, Villingen-Schwenningen, Deutschland
| | - K Krüger
- Praxiszentrum St Bonifatius, München, Deutschland
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18
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Liu RC, Consuegra G, Fernández-Peñas P. Management of the cutaneous adverse effects of antimelanoma therapy. Melanoma Manag 2017; 4:187-202. [PMID: 30190925 DOI: 10.2217/mmt-2017-0015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 10/17/2017] [Indexed: 02/08/2023] Open
Abstract
The advent of targeted therapy and immunotherapy has revolutionized the management of advanced melanoma. However, these novel therapies are associated with adverse effects (AEs), of which cutaneous toxicities are the most frequently observed. These cutaneous AEs can exert significant morbidity and impact on patient quality of life, hence the recognition and management of AEs is fundamental in preventing interruption or cessation of survival-prolonging treatments. Additionally, knowledge of these AEs are necessary in order for healthcare professionals to counsel patients when starting treatment and in the initiation of AE prophylaxis. The incidence and clinical presentation of the cutaneous toxicities of novel melanoma therapies will be discussed, and treatment guidelines provided.
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Affiliation(s)
- Rose Congwei Liu
- Department of Dermatology, Westmead Hospital, Sydney 2145, Australia.,Westmead Clinical School, University of Sydney Medical School, Sydney 2145, Australia.,Department of Dermatology, Westmead Hospital, Sydney 2145, Australia.,Westmead Clinical School, University of Sydney Medical School, Sydney 2145, Australia
| | - Germana Consuegra
- Department of Dermatology, Westmead Hospital, Sydney 2145, Australia.,Westmead Clinical School, University of Sydney Medical School, Sydney 2145, Australia.,Department of Dermatology, Westmead Hospital, Sydney 2145, Australia.,Westmead Clinical School, University of Sydney Medical School, Sydney 2145, Australia
| | - Pablo Fernández-Peñas
- Department of Dermatology, Westmead Hospital, Sydney 2145, Australia.,Westmead Clinical School, University of Sydney Medical School, Sydney 2145, Australia.,Department of Dermatology, Westmead Hospital, Sydney 2145, Australia.,Westmead Clinical School, University of Sydney Medical School, Sydney 2145, Australia
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19
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Nofal A, Abdelmaksoud A, Amer H, Nofal E, Yosef A, Gharib K, Albalat W, Eldesouky F, Ebrahim HM, Abdelshafy AS, Fayed H. Sweet-Syndrom: Revision der diagnostischen Kriterien. J Dtsch Dermatol Ges 2017. [DOI: 10.1111/ddg.13350_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ahmad Nofal
- Dermatology Department; Faculty of Medicine; Zagazig University; Zagazig Ägypten
| | - Ayman Abdelmaksoud
- Mansoura Dermatology; Venereology and Leprology Hospital; Mansoura Ägypten
| | - Hala Amer
- Al-Haud Al-Marsoud Dermatology Hospital; Cairo Ägypten
| | - Eman Nofal
- Dermatology Department; Faculty of Medicine; Zagazig University; Zagazig Ägypten
| | - Ayman Yosef
- Dermatology Department; Faculty of Medicine; Zagazig University; Zagazig Ägypten
| | - Khaled Gharib
- Dermatology Department; Faculty of Medicine; Zagazig University; Zagazig Ägypten
| | - Waleed Albalat
- Dermatology Department; Faculty of Medicine; Zagazig University; Zagazig Ägypten
| | - Fatma Eldesouky
- Dermatology Department; Faculty of Medicine; Zagazig University; Zagazig Ägypten
| | - Howyda M. Ebrahim
- Dermatology Department; Faculty of Medicine; Zagazig University; Zagazig Ägypten
| | | | - Hala Fayed
- Al-Haud Al-Marsoud Dermatology Hospital; Cairo Ägypten
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20
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Nofal A, Abdelmaksoud A, Amer H, Nofal E, Yosef A, Gharib K, Albalat W, Eldesouky F, Ebrahim HM, Abdelshafy AS, Fayed H. Sweet's syndrome: diagnostic criteria revisited. J Dtsch Dermatol Ges 2017; 15:1081-1088. [DOI: 10.1111/ddg.13350] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 06/01/2017] [Indexed: 01/06/2023]
Affiliation(s)
- Ahmad Nofal
- Dermatology Department; Faculty of Medicine; Zagazig University; Zagazig Egypt
| | - Ayman Abdelmaksoud
- Mansoura Dermatology; Venereology and Leprology Hospital; Mansoura Egypt
| | - Hala Amer
- Al-Haud Al-Marsoud Dermatology Hospital; Cairo Egypt
| | - Eman Nofal
- Dermatology Department; Faculty of Medicine; Zagazig University; Zagazig Egypt
| | - Ayman Yosef
- Dermatology Department; Faculty of Medicine; Zagazig University; Zagazig Egypt
| | - Khaled Gharib
- Dermatology Department; Faculty of Medicine; Zagazig University; Zagazig Egypt
| | - Waleed Albalat
- Dermatology Department; Faculty of Medicine; Zagazig University; Zagazig Egypt
| | - Fatma Eldesouky
- Dermatology Department; Faculty of Medicine; Zagazig University; Zagazig Egypt
| | - Howyda M. Ebrahim
- Dermatology Department; Faculty of Medicine; Zagazig University; Zagazig Egypt
| | | | - Hala Fayed
- Al-Haud Al-Marsoud Dermatology Hospital; Cairo Egypt
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