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Moreno-Artero E, Torrelo A. Pediatric Neutrophilic Dermatoses. Dermatol Clin 2024; 42:267-283. [PMID: 38423686 DOI: 10.1016/j.det.2023.12.005] [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
The term neutrophilic dermatosis encompasses a heterogeneous group of diseases, often associated with an underlying internal noninfectious disease, with an overlapping histopathologic background characterized by perivascular and diffuse neutrophilic infiltrates in one or more layers of the skin; extracutaneous neutrophilic infiltrates may be associated. Neutrophilic dermatoses are not frequent in children and, when they appear in this age group, represent a diagnostic and therapeutic challenge. Apart from the classic neutrophilic dermatoses such as pyoderma gangrenosum, Sweet syndrome, and Behçet disease, a neutrophilic dermatosis can be the presentation of rare genetic diseases of the innate immune system, such as autoinflammatory diseases.
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Affiliation(s)
- Ester Moreno-Artero
- Department of Dermatology, Hospital de Galdácano-Usansolo, Vizcaya, Bilbao 48007, Spain
| | - Antonio Torrelo
- Department of Dermatology, Hospital Infantil Universitario Niño Jesús, Menendez Pelayo 65, Madrid 28009, Spain.
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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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Neutrophilic Dermatoses in a Clinical Practice of Wound Care Professionals. Adv Skin Wound Care 2022; 35:1-8. [PMID: 35703854 DOI: 10.1097/01.asw.0000826832.69141.e4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Diagnosing and treating neutrophilic dermatoses (NDs) in clinical practice can be challenging because of various presentations and stubborn treatment responses. Establishing a diagnosis is necessary, though, because many NDs are associated with underlying conditions, including malignancy. In this article, the authors provide information about Sweet syndrome, pyoderma gangrenosum, and other NDs and describe their clinical presentation, pathophysiology, diagnostic criteria, and associated conditions. The authors also present a case report describing the coexistence of two NDs and hidradenitis suppurativa in one patient and review the treatment modalities for those conditions.
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Jung EH, Park JH, Hwan Kim K, Kim JS, Sil Choi I, Byun JM, Koh Y, Shin DY, Hong J, Yoon SS, Park H, Kim I. Characteristics of Sweet syndrome in patients with or without malignancy. Ann Hematol 2022; 101:1499-1508. [PMID: 35482090 DOI: 10.1007/s00277-022-04850-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/19/2022] [Indexed: 11/30/2022]
Abstract
Sweet syndrome is a neutrophilic dermatosis occasionally associated with malignancies. Due to its rarity, the clinical features of Sweet syndrome are still unclear. Thus, we aimed to analyze clinical features, treatment, and outcomes of these patients according to associated disease. We conducted a retrospective, longitudinal cohort study from January 2000 to August 2020. We reviewed the medical records of 52 patients with Sweet syndrome. The median age of patients was 57.5 years old (range, 17-84), and 48.1% were female. Of the 52 patients analyzed, 27 patients (51.9%) had malignancy-associated Sweet syndrome. Sweet syndrome was diagnosed concurrently with (N = 8), before (N = 5), and after (N = 14) the diagnosis of malignancy. The idiopathic Sweet syndrome was most common in the non-malignancy group (56.0%). Myelodysplastic syndrome was the most common malignancy associated with Sweet syndrome (47.6%). Leukopenia (p = 0.005), anemia (p < 0.001), and thrombocytopenia (p = 0.008) were significantly associated with malignancy. The majority of patients showed rapid improvement of symptoms after steroid administration. The symptoms of some patients with malignancy did not improve with steroid alone; however, their symptoms often improved when steroids were combined with a treatment for the associated malignancy. Relapse and aggravation of Sweet syndrome were common in the malignancy group. Sweet syndrome showed a broad spectrum of clinical features related to various diseases. Sweet syndrome often occurred as a paraneoplastic feature. Therefore, active systemic evaluation is needed in the first diagnosis of Sweet syndrome without clear etiology.
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Affiliation(s)
- Eun Hee Jung
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Jin Hyun Park
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Ki Hwan Kim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Jin-Soo Kim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - In Sil Choi
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Ja Min Byun
- Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul, 03080, South Korea
| | - Youngil Koh
- Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul, 03080, South Korea
| | - Dong-Yeop Shin
- Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul, 03080, South Korea
| | - Junshik Hong
- Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul, 03080, South Korea
| | - Sung-Soo Yoon
- Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul, 03080, South Korea
| | - Hyunkyung Park
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea.
- Department of Hematology and Oncology, Seoul National University, Boramae Medical Center 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, South Korea.
| | - Inho Kim
- Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul, 03080, South Korea.
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Cutaneous manifestations of monoclonal gammopathy. Blood Cancer J 2022; 12:58. [PMID: 35411042 PMCID: PMC9001632 DOI: 10.1038/s41408-022-00661-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/17/2022] [Accepted: 02/23/2022] [Indexed: 12/29/2022] Open
Abstract
Monoclonal gammopathy associated with dermatological manifestations are a well-recognized complication. These skin disorders can be associated with infiltration and proliferation of a malignant plasma cells or by a deposition of the monoclonal immunoglobulin in a nonmalignant monoclonal gammopathy. These disorders include POEMS syndrome, light chain amyloidosis, Schnitzler syndrome, scleromyxedema and TEMPI syndrome. This article provides a review of clinical manifestations, diagnostics criteria, natural evolution, pathogenesis, and treatment of these cutaneous manifestations.
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Sweet syndrome with osseous and splenic involvement: A case report. Radiol Case Rep 2021; 17:194-200. [PMID: 34815826 PMCID: PMC8593262 DOI: 10.1016/j.radcr.2021.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/10/2021] [Accepted: 10/11/2021] [Indexed: 01/24/2023] Open
Abstract
Sweet syndrome is an uncommon inflammatory skin condition. Here we present a case of Sweet syndrome in a young woman with rare extracutaneous manifestations, including bone and splenic fluid collections, with marked improvement following treatment with systemic corticosteroids. The patient was subsequently diagnosed with Crohn's disease which can be seen in the setting of Sweet syndrome. Sterile abscesses should be considered in patients with a clinical diagnosis of Sweet syndrome and focal symptomatology.
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Key Words
- AFB, acid fast bacilli
- ANA, antinuclear antibodies
- Abscess
- Acute febrile neutrophilic dermatosis
- CRMO, chronic recurrent multifocal osteomyelitis
- CRP, c-reactive protein
- Crohn's disease
- EKG, electrocardiogram
- ESR, erythrocyte sedimentation rate
- GI, gastrointestinal
- H&E, hematoxylin and eosin
- Osteomyelitis
- PICC, peripherally inserted central catheter
- RF, rheumatoid factor
- SS, Sweet syndrome
- Sweet syndrome
- WBC, white blood cell
- p-ANCA, perinuclear-antineutrophil cytoplasmic antibodies
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Sleiman J, Hitawala AA, Cohen B, Falloon K, Simonson M, Click B, Khanna U, Fernandez AP, Rieder F. Systematic Review: Sweet Syndrome Associated with Inflammatory Bowel Disease. J Crohns Colitis 2021; 15:1864-1876. [PMID: 33891004 PMCID: PMC8675328 DOI: 10.1093/ecco-jcc/jjab079] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND AIMS Sweet syndrome [SS] is a dermatological condition associated with both inflammatory bowel disease [IBD] and azathioprine use. We performed a systematic review to better delineate clinical characteristics and outcomes of SS in IBD patients. METHODS Peer-reviewed, full-text journal publications from inception to April 2020 in English language and adult subjects with IBD were included. Skin biopsy was required as SS gold-standard diagnosis. Azathioprine-associated SS required recent azathioprine introduction or recurrence of SS after azathioprine re-challenge. RESULTS We included 89 publications with 95 patients [mean age of SS diagnosis: 44 years; 59% female; 20 with azathioprine-associated SS and 75 without]. SS was diagnosed prior to IBD in 5.3%, at time of IBD diagnosis in 29.5% and after diagnosis in 64.2%. In total, 91% of patients with SS had known colonic involvement and the majority [76%] had active IBD at diagnosis; 22% had additional extra-intestinal manifestations. Successful therapies for SS included corticosteroids [90.5%], anti-tumour necrosis factor [TNF]-α inhibitor therapy [14.8%] and azathioprine [11.6%]. Azathioprine-associated SS was distinct, with 85% male patients, mean age of SS diagnosis of 50 years and a lower likelihood to be prescribed corticosteroids for treatment [75% vs 94.7% of non-azathioprine-associated SS, p = 0.008]. All patients with azathioprine-associated SS improved with medication cessation and developed recurrence after re-challenge. CONCLUSIONS SS may precede or occur with IBD diagnosis in almost one-third of cases. Azathioprine and IBD-associated SS present and behave distinctly, especially with regard to gender, age at diagnosis and recurrence risk. Corticosteroids and TNF-α inhibitors have demonstrated efficacy in treating SS in IBD.
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Affiliation(s)
- Joseph Sleiman
- Department of Internal Medicine, Cleveland
Clinic, Cleveland, OH, USA
| | - Asif A Hitawala
- Department of Internal Medicine, Cleveland
Clinic, Cleveland, OH, USA
| | - Benjamin Cohen
- Department of Gastroenterology, Hepatology and Nutrition,
Digestive Diseases and Surgery Institute, Cleveland Clinic,
Cleveland, OH, USA
| | - Katie Falloon
- Department of Gastroenterology, Hepatology and Nutrition,
Digestive Diseases and Surgery Institute, Cleveland Clinic,
Cleveland, OH, USA
| | - Marian Simonson
- Floyd D. Loop Alumni Library, Cleveland
Clinic, Cleveland, OH, USA
| | - Benjamin Click
- Department of Gastroenterology, Hepatology and Nutrition,
Digestive Diseases and Surgery Institute, Cleveland Clinic,
Cleveland, OH, USA
| | - Urmi Khanna
- Department of Dermatology, Albert Einstein College of
Medicine/Montefiore Medical Center, Bronx,
NY, USA
| | - Anthony P Fernandez
- Departments of Dermatology and Pathology, Cleveland
Clinic, Cleveland, OH, USA
| | - Florian Rieder
- Department of Gastroenterology, Hepatology and Nutrition,
Digestive Diseases and Surgery Institute, Cleveland Clinic,
Cleveland, OH, USA
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Abstract
In contrast to the obligatory paraneoplasias, which are usually rare, diseases such as Sweet's syndrome, thrombophlebitis or herpes zoster are more common. But they are less frequently associated with neoplasia. The risk of overlooking an associated neoplasm is therefore greater. In this article, prototypic diseases are presented with their clinical appearance, possible pathogenesis and treatment options; this is accompanied by raising awareness of potential associations with cancer. The emphasis on the distinct features of the neoplasm-associated forms should enable more reliable detection of these variants and hopefully contribute to an earlier diagnosis of associated neoplasms. These peculiarities include the jumping or wandering thrombophlebitis occurring as Trousseau's syndrome, recurrent, severe courses with involvement of the oral mucosa in Sweet's syndrome or the necrotizing, gangrenous clinical course, often with a multisegment distribution pattern of herpes zoster. Studies on the association of facultative cutaneous paraneoplasias with certain tumors are presented. However, no general recommendation for tumor screening in patients with herpes zoster, Sweet's syndrome or thrombophlebitis can be given. In atypical courses, particularly severe manifestations or the absence of other causes, more extensive diagnostic procedures appear appropriate in order not to miss possibly associated neoplasms.
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Affiliation(s)
- M Neis
- Hautklinik, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
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Keskinyan VS, Noyd DH, Underwood CM, Van Mater D. Sweet Syndrome in Pediatric Acute Myeloid Leukemia. J Pediatr Hematol Oncol 2021; 43:31-32. [PMID: 32925399 PMCID: PMC7736186 DOI: 10.1097/mph.0000000000001900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | - David H. Noyd
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Duke University Medical Center
| | | | - David Van Mater
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Duke University Medical Center
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10
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Agarwal S. Update on Sweet Syndrome in Eosinophilic Granulomatosis With Polyangiitis. J Rheumatol 2021; 48:151. [PMID: 33060325 DOI: 10.3899/jrheum.200993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Sharat Agarwal
- North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Orthopaedics, Meghalaya, India.
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Ferdjallah A, Boull CL, Stefanski H, Ebens CL. A diffuse rash in a patient after allogeneic hematopoietic stem cell transplant for AML. Clin Case Rep 2020; 8:3625-3627. [PMID: 33364009 PMCID: PMC7752433 DOI: 10.1002/ccr3.3306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/31/2020] [Accepted: 08/12/2020] [Indexed: 11/10/2022] Open
Abstract
Sweet's syndrome associated with relapse of leukemia suggests abnormal neutrophil response to transformation of dysfunctional leukemia blast cells, and hence, relapse should be excluded in similar clinical situation.
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Affiliation(s)
- Asmaa Ferdjallah
- Division of Hematology and OncologyUniversity of Minnesota Masonic Children’s HospitalMinneapolisMinnesotaUSA
| | - Christina L. Boull
- Division of Pediatric DermatologyUniversity of Minnesota Masonic Children’s HospitalMinneapolisMinnesotaUSA
| | - Heather Stefanski
- Division of Blood and Marrow TransplantationDepartment of PediatricsUniversity of Minnesota Masonic Children’s HospitalMinneapolisMinnesotaUSA
| | - Christen L. Ebens
- Division of Blood and Marrow TransplantationDepartment of PediatricsUniversity of Minnesota Masonic Children’s HospitalMinneapolisMinnesotaUSA
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PĂtraŞcu V, Geoloaica LG, Ciurea RN. Recurrent Idiopathic Sweet Syndrome - Case Report and Literature Review. CURRENT HEALTH SCIENCES JOURNAL 2020; 46:90-98. [PMID: 32637170 PMCID: PMC7323719 DOI: 10.12865/chsj.46.01.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 01/15/2020] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Sweet syndrome (SS), also denominated as acute febrile neutrophilic dermatosis, is a rare disease characterized by the sudden onset of painful, erythematous, firm skin lesions (papules, plaques, and nodules) which show, upon histologic examination, the presence of a diffuse infiltrate of mature neutrophils. The cutaneous manifestation typically involves the face, neck, trunk, and upper limbs and is associated with fever, general malaise, arthralgia. CASE REPORT A female patient, 60 years old, attended the Dermatology Clinic due to the appearance of violaceous erythematous-oedematous infiltrated plaques, located on the face, neck, upper limbs, trunk and knees. The onset of the cutaneous manifestation had occurred 2 months prior, accompanied by pain, chills, flares of fever and arthralgia. The onset coincided with the surgical treatment of an umbilical hernia. From the medical history we note that the patient was diagnosed in 2014 with histiocytoid SS. She followed a treatment with methylprednisolone, with positive response, but had many relapses after the discontinuation of treatment. In 2017, due to a new episode, the histopathological examination was repeated, which revealed classical SS. She received treatment with Disulone and Colchicine. She had not been administered any treatment throughout the previous year. Laboratory tests revealed leukocytosis with neutrophils, increased ESR, elevated C4, hyperglycemia. The current histopathological examination revealed lymphocytic SS. Under treatment with methylprednisolone 32mg/day, the evolution was favorable. DISCUSSIONS The first case of SS was described by Robert Douglas Sweet in 1964. As known aetiological factors there have been described gastrointestinal and urinary tract infections, pregnancy, inflammatory bowel disease, drugs or malignancies. There have been described cases of SS that appeared after surgical treatment, as in our case, which registered a new outbreak following the umbilical hernia treatment. The histopathological variants of SS described in the literature are: subcutaneous, eosinophilic, histiocytoid, lymphocytic type. The first line-therapy consists in systemic corticosteroids, which induce a fast remission of lesions and general symptoms. Recurrence may occur in approximately 50% of patients and is common in idiopathic or paraneoplastic cases. CONCLUSIONS In addition to the neutrophilic infiltrate that is typical for Sweet syndrome, different types of histological manifestations have been described in the literature: subcutaneous, eosinophilic, histiocytoid, lymphocytic. In our case, we noted that the histological profile changed over time, from a histiocytoid SS recorded in 2014, to a classical SS in 2017, followed by the appearance of lymphocytic SS in 2019. Due to the fact that SS can be associated with a numerous other disorders, our patient requires regular monitoring with a view to eliminate them, and potentially to make a diagnosis and initiate early specific treatment.
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Affiliation(s)
- Virgil PĂtraŞcu
- Department of Dermatology, Emergency County Hospital, Craiova, University of Medicine and Pharmacy of Craiova, Romania
| | - Liliana Gabriela Geoloaica
- Department of Dermatology, Emergency County Hospital, Craiova, University of Medicine and Pharmacy of Craiova, Romania
| | - Raluca Niculina Ciurea
- Department of Pathology, Emergency County Hospital, Craiova, University of Medicine and Pharmacy of Craiova, Romania
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Mehrtens SH, Hasan ZU, Halpern SM, McLornan DP. Sweet’s syndrome with pulmonary involvement. BMJ Case Rep 2019; 12:12/8/e229997. [DOI: 10.1136/bcr-2019-229997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Sweet’s syndrome is an acute febrile neutrophilic dermatosis with classical clinical features. Systemic manifestations in Sweet’s syndrome including fever, arthralgia, myalgia and ocular involvement are common. Pulmonary involvement is a rare manifestation that has been reported previously in 34 cases and can be fatal if left untreated. We report a striking case of Sweet’s syndrome with respiratory failure secondary to bilateral pulmonary interstitial infiltrates, which rapidly responded to intravenous corticosteroid therapy. This case is an important reminder of the systemic manifestations of Sweet’s syndrome and highlights the value of collaboration between different medical specialities to optimise patient management and outcomes.
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Salem I, Kimak M, Conic R, Bragazzi NL, Watad A, Adawi M, Bridgewood C, Pacifico A, Santus P, Rizzi M, Petrou S, Colombo D, Fiore M, Pigatto PDM, Damiani G. Neutrophilic Dermatoses and Their Implication in Pathophysiology of Asthma and Other Respiratory Comorbidities: A Narrative Review. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7315274. [PMID: 31281845 PMCID: PMC6590566 DOI: 10.1155/2019/7315274] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 05/14/2019] [Indexed: 01/20/2023]
Abstract
Neutrophilic dermatoses (ND) are a polymorphous group of noncontagious dermatological disorders that share the common histological feature of a sterile cutaneous infiltration of mature neutrophils. Clinical manifestations can vary from nodules, pustules, and bulla to erosions and ulcerations. The etiopathogenesis of neutrophilic dermatoses has continuously evolved. Accumulating genetic, clinical, and histological evidence point to NDs being classified in the spectrum of autoinflammatory conditions. However, unlike the monogenic autoinflammatory syndromes where a clear multiple change in the inflammasome structure/function is demonstrated, NDs display several proinflammatory abnormalities, mainly driven by IL-1, IL-17, and tumor necrosis factor-alpha (TNF-a). Additionally, because of the frequent association with extracutaneous manifestations where neutrophils seem to play a crucial role, it was plausible also to consider NDs as a cutaneous presentation of a systemic neutrophilic condition. Neutrophilic dermatoses are more frequently recognized in association with respiratory disorders than by chance alone. The combination of the two, particularly in the context of their overlapping immune responses mediated primarily by neutrophils, raises the likelihood of a common neutrophilic systemic disease or an aberrant innate immunity disorder. Associated respiratory conditions can serve as a trigger or may develop or be exacerbated secondary to the uncontrolled skin disorder. Physicians should be aware of the possible pulmonary comorbidities and apply this knowledge in the three steps of patients' management, work-up, diagnosis, and treatment. In this review, we attempt to unravel the pathophysiological mechanisms of this association and also present some evidence for the role of targeted therapy in the treatment of both conditions.
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Affiliation(s)
- Iman Salem
- Department of Dermatology, Case Western Reserve University, Cleveland, USA
| | - Mark Kimak
- Department of Dermatology, Case Western Reserve University, Cleveland, USA
| | - Rosalynn Conic
- Department of Dermatology, Case Western Reserve University, Cleveland, USA
| | - Nicola L. Bragazzi
- Department of Health Sciences (DISSAL), School of Public Health, University of Genoa, Genoa, Italy
| | - Abdulla Watad
- Department of Medicine “B”, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
| | - Mohammad Adawi
- Padeh and Ziv Hospitals, Azrieli Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
| | - Charlie Bridgewood
- Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
| | | | - Pierachille Santus
- Department of Biomedical Sciences L. Sacco, University of Milan, Milan, Italy
- Respiratory Unit, Center for Sleep and Respiratory Disorders, “Luigi Sacco” University Hospital, Milan, Italy
| | - Maurizio Rizzi
- Respiratory Unit, Center for Sleep and Respiratory Disorders, “Luigi Sacco” University Hospital, Milan, Italy
| | - Stephen Petrou
- Emergency Medicine, Good Samaritan Hospital Medical Center, New York, USA
| | - Delia Colombo
- Department of Pharmacology, University of Milan, Milan, Italy
| | - Marco Fiore
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Paolo D. M. Pigatto
- Clinical Dermatology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Giovanni Damiani
- Department of Dermatology, Case Western Reserve University, Cleveland, USA
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Clinical Dermatology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Young Dermatologists Italian Network, Centro Studi GISED, Bergamo, Italy
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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15
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Fujii A, Mizutani Y, Hattori Y, Takahashi T, Ohnishi H, Yoshida S, Seishima M. Sweet's Syndrome Successfully Treated with Granulocyte and Monocyte Adsorption Apheresis. Case Rep Dermatol 2017; 9:13-18. [PMID: 28611630 PMCID: PMC5465522 DOI: 10.1159/000475878] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 04/20/2017] [Indexed: 01/24/2023] Open
Abstract
Sweet's syndrome is a neutrophilic dermatosis characterized by an abrupt onset of painful erythematous lesions showing neutrophilic infiltrates in the dermis. Fever and an elevated neutrophil level are generally observed. Sweet's syndrome may be idiopathic, malignancy-associated, or drug-induced (mainly involving granulocyte colony-stimulating factor (G-CSF) administration). Although systemic corticosteroids are usually effective, the symptoms of Sweet's syndrome recur in some refractory cases. Herein, we report a case of a 55-year-old Japanese woman with recurrent symptoms of fever (>39°C) and painful erythematous lesions on her four extremities, trunk, and neck. Laboratory findings revealed leukocytosis and high levels of C-reactive protein (CRP) and G-CSF. She was diagnosed with a recurrence of Sweet's syndrome, and was exclusively treated with granulocyte and monocyte adsorption apheresis (GMA) therapy once a week for 3 consecutive weeks. After the first session of GMA therapy, all symptoms including the erythematous lesions and fever were completely resolved, and serum G-CSF level was reduced. Leukocyte count, neutrophil count, serum amyloid A protein, and CRP levels were restored within normal ranges by 2 weeks. Thus, GMA therapy can successfully treat a patient with recurrent Sweet's syndrome, potentially related to the restoration of elevated serum G-CSF levels.
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Affiliation(s)
- Asami Fujii
- aDepartment of Dermatology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yoko Mizutani
- aDepartment of Dermatology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yuki Hattori
- aDepartment of Dermatology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Tomoko Takahashi
- aDepartment of Dermatology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hidenori Ohnishi
- bDepartment of Pediatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Shozo Yoshida
- cDepartment of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Mariko Seishima
- aDepartment of Dermatology, Gifu University Graduate School of Medicine, Gifu, Japan
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Abstract
Relapsing polychondritis, or RP, is a rare connective tissue disease characterized by relapsing-remitting destructive inflammation of the cartilaginous and other proteoglycan-rich structures in the body. Given the relatively low incidence of RP, a concise clinically relevant guide, focusing on the cutaneous manifestations of this serious disease, is lacking. In this review, we provide the dermatologist with an approach to diagnosing RP and a guide to its initial work-up, and management. We close with an overview of the currently available treatment modalities for RP.
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Aseptic Abscesses and Inflammatory Bowel Disease: Two Cases and Review of Literature. Can J Gastroenterol Hepatol 2017; 2017:5124354. [PMID: 28265555 PMCID: PMC5317120 DOI: 10.1155/2017/5124354] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 12/22/2016] [Accepted: 01/22/2017] [Indexed: 12/14/2022] Open
Abstract
Background. Aseptic abscesses (AA) are sterile lesions that represent an extraintestinal manifestation (EIM) of inflammatory bowel disease (IBD). Though Canada has the highest prevalence of IBD in the world, reports of IBD-associated AA are absent in Canada. This may represent a different IBD phenotype or underrecognition and underreporting. Purpose. To explore AA as a possible EIM of IBD and evaluate clinical and investigative findings among patients with IBD-associated AA. Methods. Retrospective chart and literature reviews were performed to find cases of IBD-associated AA at our institution and in the literature. Results. We identified 2 cases of IBD-associated AA in our institution. Both patients had ulcerative colitis and presented with fever, abdominal pain, and weight loss. Radiological workup and aspiration showed sterile splenic abscesses. The AA were unresponsive to antibiotics. One patient improved on corticosteroids and one underwent splenectomy. We retrieved 37 cases of IBD-associated AA from the literature. All patients showed no evidence of infection, failed to resolve with antibiotics, and, if attempted, improved on corticosteroids. Conclusions. Our cases are the first reported in Canada. They support literature which suggests AA as an EIM of IBD and may help increase recognition and reporting of this phenomenon.
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Elevated 18F-FDG Uptake in Skeletal Muscles Rather Than Cutaneous Foci in a Patient With Sweet's Syndrome. Clin Nucl Med 2016; 41:938-940. [PMID: 27749403 DOI: 10.1097/rlu.0000000000001382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 64-year-old man was admitted to our hospital with a history of recurrent fever lasting 2 months. The initial physical examination for the patient showed normal cutaneous signs. An elevated uptake of tracer in skeletal muscles was observed by F-FDG PET/CT imaging. Three weeks later, a multitude of painful erythematous maculopapules appeared over his face, chest, and back. Pathological examination of a skin lesion showed papillary dermal edema with predominantly dense neutrophilic infiltrate in the dermis with no evidence of vasculitis, which was consistent with Sweet's syndrome.
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Abstract
Numerous cutaneous manifestations have been reported in patients with hematologic malignancies. This review provides an overview on this subject by dividing skin lesions into three main groups: (1) skin disorders due to vascular changes (dilatation, occlusion and inflammation), (2) unspecific (e.g. paleness, opportunistic infections) and specific skin lesions (e.g. leukemia cutis), and (3) the large group of paraneoplastic skin disorders. Emphasis is placed on clinical findings and therapeutic options of those paraneoplastic syndromes that are most frequently found in hematologic malignancies.
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Biswas SN, Chakraborty PP, Gantait K, Bar C. Azathioprine-induced bullous Sweet's syndrome: a rare association. BMJ Case Rep 2016; 2016:10.1136/bcr-2016-215192. [PMID: 27090551 DOI: 10.1136/bcr-2016-215192] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 52-year-old man presented with high-grade fever, headache and painful vesicular skin rash involving the upper trunk and upper extremities, 8 days after initiation of chemotherapy with azathioprine (50 mg/day), which had been prescribed for acral vitiligo. There was neither any history of preceding respiratory or gastrointestinal tract infection, nor was the patient known to have malignancy, drug hypersensitivity, inflammatory bowel disease, vasculitis or other autoimmune disease. Laboratory results revealed leucocytosis with neutrophilia and markedly elevated acute phase reactants. Antinuclear antibody, perinuclear and cytoplasmic antineutrophil cytoplasmic antibody were found negative. Punch biopsy from skin of the upper trunk revealed dense neutrophilic infiltration of dermis without signs of vasculitis, suggestive of Sweet's syndrome. In view of the temporal association with azathioprine and absence of an obvious alternative aetiology, provisional diagnosis of drug-induced bullous Sweet's syndrome was made. Azathioprine was discontinued and high-dose oral prednisolone initiated. The response was dramatic with resolution of skin lesions within 72 h without further recurrence at fourth week of follow-up.
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Affiliation(s)
- Sugata Narayan Biswas
- Department of Medicine, Midnapore Medical College & Hospital, Midnapore, West Bengal, India
| | | | - Kripasindhu Gantait
- Department of Medicine, Midnapore Medical College & Hospital, Midnapore, West Bengal, India
| | - Chittaranjan Bar
- Department of Dermatology & Venereology, Midnapore Medical College & Hospital, Midnapore, West Bengal, India
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Kurtzman D, Vleugels RA, Callen J. Approach to and Management of the Neutrophilic Dermatoses. CURRENT DERMATOLOGY REPORTS 2016. [DOI: 10.1007/s13671-016-0129-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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22
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Beasley JM, Sluzevich JC. A recurrent vesiculobullous eruption on the head, trunk, and extremities. Bullous Sweet’s syndrome. Int J Dermatol 2015; 55:149-50. [PMID: 26267135 DOI: 10.1111/ijd.13001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 02/05/2015] [Accepted: 02/12/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Jenna M Beasley
- Department of Dermatology, Mayo Clinic, Jacksonville, FL, USA
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Seminario-Vidal L, Guerrero C, Sami N. Refractory Sweet's syndrome successfully treated with rituximab. JAAD Case Rep 2015; 1:123-5. [PMID: 27051705 PMCID: PMC4808708 DOI: 10.1016/j.jdcr.2015.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
| | - Cesar Guerrero
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Naveed Sami
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama
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Imhof L, Meier B, Frei P, Kamarachev J, Rogler G, Kolios A, Navarini AA, Contassot E, French LE. Severe Sweet's Syndrome with Elevated Cutaneous Interleukin-1β after Azathioprine Exposure: Case Report and Review of the Literature. Dermatology 2015; 230:293-8. [DOI: 10.1159/000371879] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 01/02/2015] [Indexed: 11/19/2022] Open
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Sweet syndrome secondary to inflammatory bowel disease. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2015; 27:124-5. [PMID: 23516674 DOI: 10.1155/2013/848316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Tzelepis E, Kampolis CF, Vlachadami I, Moschovi M, Alamani M, Kaltsas G. Cryptogenic organizing pneumonia in Sweet's syndrome: case report and review of the literature. CLINICAL RESPIRATORY JOURNAL 2014; 10:250-4. [PMID: 25196175 DOI: 10.1111/crj.12206] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 07/22/2014] [Accepted: 08/27/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Sweet's syndrome or acute febrile neutrophilic dermatosis is characterized by fever, leukocytosis and tender erythematous plaques, which show infiltration by mature neutrophils on histological examination. Pulmonary involvement is rare in Sweet's syndrome. METHOD We describe the case of a 17-year-old man with a myelodysplastic syndrome following therapy for Hodgkin's lymphoma who developed Sweet's syndrome and cryptogenic organizing pneumonia. In addition, we conducted a review of the related English literature. RESULTS Literature review yielded six similar reports of biopsy-proven cryptogenic organizing pneumonia associated with Sweet's syndrome. We present the clinical and laboratory characteristics, as well as the response to treatment, of all cases of cryptogenic organizing pneumonia reported in patients with Sweet's syndrome. CONCLUSIONS Cryptogenic organizing pneumonia is a rare manifestation of Sweet's syndrome, which may be complicated by respiratory failure. Prompt treatment with corticosteroids usually leads to clinical and radiographic improvement.
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Affiliation(s)
- Elias Tzelepis
- Department of Pathophysiology, 'Laiko' Hospital, University of Athens Medical School, Athens, Greece
| | - Christos F Kampolis
- Department of Pathophysiology, 'Laiko' Hospital, University of Athens Medical School, Athens, Greece
| | - Ioanna Vlachadami
- Department of Pathophysiology, 'Laiko' Hospital, University of Athens Medical School, Athens, Greece
| | - Maria Moschovi
- Department of Pediatrics, University of Athens Medical School, Athens, Greece
| | - Maria Alamani
- Department of Pathology, Henry Dunant Hospital, Athens, Greece
| | - Gregory Kaltsas
- Department of Pathophysiology, 'Laiko' Hospital, University of Athens Medical School, Athens, Greece
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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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Kim YJ, Lee HY, Lee JY, Yoon TY. Interferon beta-1b-induced Sweet's syndrome in a patient with multiple sclerosis. Int J Dermatol 2013; 54:456-8. [PMID: 23786157 DOI: 10.1111/j.1365-4632.2012.05840.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Young Jin Kim
- Department of Dermatology, School of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, South Korea
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31
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Rash and ear swelling in a patient with febrile neutropenia. Int J Infect Dis 2013; 17:e360-1. [DOI: 10.1016/j.ijid.2012.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 12/13/2012] [Accepted: 12/14/2012] [Indexed: 11/17/2022] Open
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Paydas S. Sweet's syndrome: A revisit for hematologists and oncologists. Crit Rev Oncol Hematol 2013; 86:85-95. [DOI: 10.1016/j.critrevonc.2012.09.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Revised: 08/09/2012] [Accepted: 09/06/2012] [Indexed: 12/26/2022] Open
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Affiliation(s)
- Mac Machan
- Division of Dermatology; University of Kansas Medical Center; Kansas City KS USA
| | | | - Garth R. Fraga
- Department of Pathology; University of Kansas Medical Center; Kansas City KS USA
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34
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Abstract
Neutrophilic dermatoses, including Sweet's syndrome, pyoderma gangrenosum, and rheumatoid neutrophilic dermatitis, are inflammatory conditions of the skin often associated with underlying systemic disease. These are characterized by the accumulation of neutrophils in the skin. The associated conditions, potential for systemic neutrophilic infiltration, and therapeutic management of these disorders can be similar. Sweet's syndrome can often be effectively treated with a brief course of systemic corticosteroids. Pyoderma gangrenosum, however, can be recurrent, and early initiation of a steroid-sparing agent is prudent. Second-line treatment for both of these conditions includes medications affecting neutrophil function, in addition to immunosuppressant medications.
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Affiliation(s)
- Courtney R Schadt
- Division of Dermatology, University of Louisville, 310 East Broadway, Louisville, KY 40202, USA.
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35
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Fernandez-Bussy S, Labarca G, Cabello F, Cabello H, Folch E, Majid A. Sweet's syndrome with pulmonary involvement: Case report and literature review. Respir Med Case Rep 2012; 6:16-9. [PMID: 26029596 PMCID: PMC3920571 DOI: 10.1016/j.rmcr.2012.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 08/25/2012] [Indexed: 11/15/2022] Open
Abstract
A 74 year old female presented with fever, associated with papules and plaque in her upper and lower extremities. Exams revealed blood leukocytosis and a positive urine culture. Antibiotic therapy was initiated with no clinical response. After 1 week, chest X-ray showed right upper lobe alveolar infiltrate. A skin biopsy of the lesion showed infiltration by neutrophils, consistent with Sweet's Syndrome. Patient's condition progressively worsened, requiring oxygentherapy. Bronchoscopy and bronchoalveolar lavage were normal, transbronchial biopsies suggested lung involvement of Sweet 's syndrome. Antibiotic therapy was stopped. Corticosteroid were started. Therapy resulted in rapid clinical and radiological improvement.
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Affiliation(s)
- S Fernandez-Bussy
- Interventional Pulmonology, Clinica Alemana-Universidad del Desarrollo, Santiago, Manquehue Norte 1410, Chile
| | - G Labarca
- Clinica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - F Cabello
- Universidad de Valparaiso, Santiago, Chile
| | - H Cabello
- Interventional Pulmonology, Clinica Alemana-Universidad del Desarrollo, Santiago, Manquehue Norte 1410, Chile
| | - E Folch
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - A Majid
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Sweet syndrome associated with myelodysplastic syndrome: report of a case. Review of the literature. ACTA ACUST UNITED AC 2012; 9:246-7. [PMID: 22749728 DOI: 10.1016/j.reuma.2012.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 01/20/2012] [Accepted: 01/25/2012] [Indexed: 11/21/2022]
Abstract
Sweet's syndrome or acute neutrophilic febrile dermatosis is a systemic disease of unknown etiology characterized by the appearance of skin lesions produced by a neutrophilic dermal infiltrate, fever and peripheral leukocytosis. It may be associated with hematologic diseases, including leukemia, with immune diseases as rheumatoid arthritis, or can occur in isolation. The myelodysplasias are hematological disorders characterized by one or more cytopenias secondary to bone marrow dysfunction. We present the case of a patient with Sweet's syndrome associated with myelodysplastic syndrome and treated with glucocorticoids who did not present a good clinical outcome. We discuss the different treatment of these diseases because in most cases glucocorticoids, which are the treatment of choice in Sweet's syndrome, may be insufficient.
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37
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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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38
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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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Park CW, Kim YJ, Seo HJ, Lee KI, Jang BK, Hwang JS, Chung WJ. A Case of Sweet's Syndrome in a Patient with Liver Cirrhosis Caused by Chronic Hepatitis B. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2012; 59:441-4. [DOI: 10.4166/kjg.2012.59.6.441] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Chang Wook Park
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Yoon Jung Kim
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Hye Jin Seo
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Kyung In Lee
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Byung Kuk Jang
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Jae Seok Hwang
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Woo Jin Chung
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
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Keidel S, McColl A, Edmonds S. Sweet's syndrome after adalimumab therapy for refractory relapsing polychondritis. BMJ Case Rep 2011; 2011:bcr.10.2011.4935. [PMID: 22670004 DOI: 10.1136/bcr.10.2011.4935] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Relapsing polychondritis and Sweet's syndrome are rare systemic inflammatory conditions. The authors present a patient who developed Sweet's syndrome 1 week after adalimumab therapy for refractory relapsing polychondritis. Coexistent relapsing polychondritis and Sweet's syndrome is rare, however, is likely to represent a true disease association and signifies a high risk of myelodysplasia. Antitumour necrosis factor α (TNFα) therapy is a treatment option in both relapsing polychondritis and Sweet's syndrome, and switching anti-TNFα agents may be feasible in the event of adverse reaction.
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Affiliation(s)
- Sarah Keidel
- Department of Rheumatology, Stoke Mandeville Hospital, Aylesbury, UK.
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41
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Rosmaninho A, Lobo I, Selores M. Sweet’s syndrome associated with the intake of a selective cyclooxygenase-2 (COX-2) inhibitor. Cutan Ocul Toxicol 2011; 30:298-301. [DOI: 10.3109/15569527.2011.579929] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Francisco CRI, Patal PC, Cubillan EA, Isip-Tan IT. Sweet's syndrome associated with Hashimoto's thyroiditis. BMJ Case Rep 2011; 2011:bcr.02.2011.3921. [PMID: 22678935 DOI: 10.1136/bcr.02.2011.3921] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Sweet's syndrome or acute febrile neutrophilic dermatosis is characterised by the abrupt onset of painful erythematous plaques or nodules, pyrexia (>38°F) and histopathologic evidence of a dense neutrophilic infiltrate without vasculitis. It has been reported in association with many diseases, however, its association with Hashimoto's thyroiditis is rare. A 47-year-old Filipino woman with a 30-year history of an asymptomatic anterior neck mass developed painful, erythematous annular plaques on her arms with associated fever. Skin biopsy confirmed the diagnosis of Sweet's syndrome. The anterior neck mass was confirmed to be Hashimoto's thyroiditis. This is a rare association with only two reported cases in the literature. There are no published cases in the Philippines on Sweet's syndrome and Hashimoto's thyroiditis to date.
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Diamantino FDER, Raimundo PMODC, Fidalgo AIPC. Síndrome de Sweet e policondrite recidivante reveladores de síndrome mielodisplásica. An Bras Dermatol 2011; 86:S173-7. [DOI: 10.1590/s0365-05962011000700045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Accepted: 12/22/2010] [Indexed: 11/22/2022] Open
Abstract
Certas dermatoses, pertencentes ao grupo das síndromes paraneoplásicas mucocutâneas, podem ser o prenúncio de uma neoplasia previamente não conhecida. Tanto a síndrome de Sweet como a policondrite recidivante incluem-se neste grupo. A síndrome de Sweet e a PR são raramente encontradas em um mesmo paciente. A presença de policondrite recidivante e síndrome de Sweet em um mesmo paciente tem se revelado mais frequente em pacientes com neoplasias associadas, sobretudo hematológicas. Relata-se o caso de paciente do sexo masculino, 79 anos, com síndrome de Sweet e policondrite recidivante, em quem, subsequentemente, foi diagnosticada uma síndrome mielodisplásica
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Terai T, Sugimoto M, Osawa S, Sugimoto K, Furuta T, Kanaoka S, Ikuma M. Successful treatment of ulcerative colitis complicated by Sweet’s syndrome by corticosteroid therapy and leukocytapheresis. Clin J Gastroenterol 2011; 4:151-156. [DOI: 10.1007/s12328-011-0215-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Accepted: 02/14/2011] [Indexed: 12/12/2022]
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45
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Lobo AM, Stacy R, Cestari D, Stone JH, Jakobiec FA, Sobrin L. Optic Nerve Involvement with Panuveitis in Sweet Syndrome. Ocul Immunol Inflamm 2011; 19:167-70. [DOI: 10.3109/09273948.2011.560411] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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46
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Dabade TS, Davis MDP. Diagnosis and treatment of the neutrophilic dermatoses (pyoderma gangrenosum, Sweet's syndrome). Dermatol Ther 2011; 24:273-84. [DOI: 10.1111/j.1529-8019.2011.01403.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Abstract
Sweet syndrome, also referred to as acute febrile neutrophilic dermatosis, is characterized by tender, red inflammatory nodules or papules that occur in association with infection, malignancy, connective tissue disease, or following exposure to certain drugs. Although drug-induced Sweet syndrome is rare, granulocyte colony-stimulating factor, all-trans-retinoic acid, and miscellaneous drugs have been implicated in causing this disorder in adults. In pediatric patients, granulocyte colony-stimulating factor, all-trans-retinoic acid, trimethoprim-sulfamethoxazole, and azathioprine have been implicated as potential causes of drug-induced Sweet syndrome. To date, six cases, including the patient reported here, have been reported in children.
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Affiliation(s)
- Mi Jin Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, South Korea
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48
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Abbas O, Kibbi AG, Rubeiz N. Sweet’s syndrome: retrospective study of clinical and histologic features of 44 cases from a tertiary care center. Int J Dermatol 2010; 49:1244-9. [DOI: 10.1111/j.1365-4632.2009.04233.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lund JJ, Stratman EJ, Jose D, Xia L, Wilson D, Moizuddin M. Drug-induced bullous sweet syndrome with multiple autoimmune features. Autoimmune Dis 2010; 2011:176749. [PMID: 21152216 PMCID: PMC2989706 DOI: 10.4061/2010/176749] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 06/25/2010] [Accepted: 08/01/2010] [Indexed: 11/26/2022] Open
Abstract
Sweet syndrome (SS) (Acute Febrile Neutrophilic Dermatosis) has been reported in association with autoimmune phenomena including relapsing polychondritis, drug-induced lupus, and the development of antineutrophil cytoplasmic antibodies (ANCAs). However, a combination of these autoimmune features has not been reported. Herein, we report a case of drug-induced bullous SS with ocular and mucosal involvement, glomerulonephritis, and multiple autoimmune features including clinical polychondritis with antitype II collagen antibodies, ANCAs, antinuclear (HEp-2), and antihistone antibodies in a patient on hydralazine and carbamazepine.
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Affiliation(s)
- Jared J Lund
- Department of Dermatology, Marshfield Clinic, 1000 N. Oak Avenue, Marshfield, 54449, USA
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