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Elidrissi EH, Elaissat EM, Assoufi N, Tbouda M. Association of Sweet's Syndrome and Behçet's Disease: Is It Possible? A Case Report. Eur J Case Rep Intern Med 2023; 10:004073. [PMID: 37789984 PMCID: PMC10545150 DOI: 10.12890/2023_004073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 08/28/2023] [Indexed: 10/05/2023] Open
Abstract
Introduction Behçet's disease is a systemic vasculitis characterized by a large clinical polymorphism with a particular frequency of cutaneous signs. Sweet's syndrome is a neutrophilic dermatosis marked by the sudden appearance of painful skin lesions in the form of erythematous papules, nodules or plaques. This syndrome is associated with high fever, neutrophilia and histologically a diffuse infiltrate of neutrophils in the dermis. Observation We report the case of a 43-year-old patient followed for Behçet's disease, who developed cutaneous plaques of neutrophilic dermatosis of both upper limbs. The clinical and biological picture was in favor of Sweet's syndrome. Conclusion The coexistence of Sweet's syndrome and Behçet's disease is already reported in the literature. The association is however very rare given the differences in the clinical and pathogenic features between the two conditions. LEARNING POINTS The appearance of neutrophilic dermatosis during a skin flare-up of Behçet's disease alerted us to a possible link between Sweet's syndrome and Behçet's disease.The morphology of the skin lesions associated with these pathologies is heterogeneous, making diagnosis sometimes difficult.Cases reported in the literature concerning the association between Sweet's syndrome and Behçet's disease are rare.
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Affiliation(s)
- El Houcine Elidrissi
- Department of Internal Medicine, Military Hospital "Oued DAHAB", Agadir, Morocco
| | - El Mehdi Elaissat
- Department of Internal Medicine, Military Hospital "Oued DAHAB", Agadir, Morocco
| | - Naoufal Assoufi
- Department of Internal Medicine, Military Hospital "Oued DAHAB", Agadir, Morocco
| | - Mohamed Tbouda
- Anatomo-Pathology Department, Military Hospital "Oued DAHAB", Agadir, Morocco
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2
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Belicard F, Belhomme N, Bouzy S, Saillard C, Nedelec F, Mear JB, Ardois S, Pastoret C, Reizine F, Camus C, Painvin B. Vacuoles, E1 enzyme, X-linked, autoinflammatory, and somatic syndrome in the intensive care unit: a case report. J Med Case Rep 2023; 17:314. [PMID: 37480098 PMCID: PMC10362754 DOI: 10.1186/s13256-023-04034-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 06/11/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Vacuoles, E1 enzyme, X-linked, autoinflammatory, and somatic syndrome is a newly discovered inflammatory disease affecting male subjects, for which few data exist in the literature. Here, we describe the case of a patient with known Sweet's syndrome admitted to the intensive care unit and for whom a vacuoles, E1 enzyme, X-linked, autoinflammatory, and somatic syndrome was diagnosed, allowing for appropriate treatment and the patient's discharge and recovery. CASE PRESENTATION A 70-year-old male White patient was hospitalized in the intensive care unit following an intrahospital cardiac arrest. History started a year before with repeated deep vein thrombosis and episodes of skin eruption compatible with Sweet's syndrome. After a course of oral steroids, fever and inflammatory syndrome relapsed with onset of polychondritis, episcleritis along with neurological symptoms and pulmonary infiltrates. Intrahospital hypoxic cardiac arrest happened during patient's new investigations, and he was admitted in a critical state. During the intensive care unit stay, he presented with livedoid skin lesions on both feet. Vasculitis was not proven; however, cryoglobulinemia screening came back positive. Onset of pancytopenia was explored with a myelogram aspirate. It showed signs of dysmyelopoiesis and vacuoles in erythroid and myeloid precursors. Of note, new deep vein thrombosis developed, despite being treated with heparin leading to the diagnosis of heparin-induced thrombocytopenia. The course of symptoms were overlapping multiple entities, and so a multidisciplinary team discussion was implemented. Screening for UBA1-mutation in the blood came back positive, confirming the vacuoles, E1 enzyme, X-linked, autoinflammatory, and somatic syndrome. Corticosteroids and anti-IL1 infusion were started with satisfactory results supporting patient's discharge from intensive care unit to the internal medicine ward. CONCLUSIONS Vacuoles, E1 enzyme, X-linked, autoinflammatory, and somatic syndrome should be suspected in male patients presenting with inflammatory symptoms, such as fever, skin eruption, chondritis, venous thromboembolism, and vacuoles in bone marrow precursors. Patients with undiagnosed vacuoles, E1 enzyme, X-linked, autoinflammatory, and somatic syndrome may present with organ failure requiring hospitalization in intensive care unit, where screening for UBA1 mutation should be performed when medical history is evocative. Multidisciplinary team involvement is highly recommended for patient management, notably to start appropriate immunosuppressive treatments.
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Affiliation(s)
- Félicie Belicard
- Service de Réanimation Médicale et des Maladies Infectieuses, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, 2 rue Henri le Guilloux, 35033, Rennes Cedex 9, France
| | - Nicolas Belhomme
- Internal Medicine Department, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, 2 rue Henri le Guilloux, 35033, Rennes Cedex 9, France
| | - Simon Bouzy
- Hematology Laboratory Department, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, 2 rue Henri le Guilloux, 35033, Rennes Cedex 9, France
| | - Clémence Saillard
- Dermatology Department, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, 2 rue Henri le Guilloux, 35033, Rennes Cedex 9, France
| | - Fabienne Nedelec
- Hemostasis Laboratory Department, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, 2 rue Henri le Guilloux, 35033, Rennes Cedex 9, France
| | - Jean-Baptiste Mear
- Hematology Department, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, 2 rue Henri le Guilloux, 35033, Rennes Cedex 9, France
| | - Samuel Ardois
- Internal Medicine Department, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, 2 rue Henri le Guilloux, 35033, Rennes Cedex 9, France
| | - Cedric Pastoret
- Hematology Laboratory Department, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, 2 rue Henri le Guilloux, 35033, Rennes Cedex 9, France
| | - Florian Reizine
- Service de Réanimation Médicale et des Maladies Infectieuses, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, 2 rue Henri le Guilloux, 35033, Rennes Cedex 9, France
| | - Christophe Camus
- Service de Réanimation Médicale et des Maladies Infectieuses, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, 2 rue Henri le Guilloux, 35033, Rennes Cedex 9, France
| | - Benoit Painvin
- Service de Réanimation Médicale et des Maladies Infectieuses, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, 2 rue Henri le Guilloux, 35033, Rennes Cedex 9, France.
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3
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Bellemare J, El Fassy HL, Mereniuk A. Ixazomib-induced Sweet's syndrome: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231181034. [PMID: 37342419 PMCID: PMC10278404 DOI: 10.1177/2050313x231181034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 05/01/2023] [Indexed: 06/22/2023] Open
Abstract
Ixazomib, a proteasome inhibitor commonly used for the treatment of multiple myeloma, is a rare cause of Sweet's syndrome. We present a 62-year-old man who developed drug-induced Sweet's syndrome during his fifth cycle of ixazomib for treatment of refractory multiple myeloma. Monthly rechallenge led to the recurrence of symptoms. The patient was successfully treated with addition of weekly corticosteroids and resumed his cancer treatment.
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Affiliation(s)
- Jeanne Bellemare
- Division of Dermatology, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, QC, Canada
| | - Hannah Laure El Fassy
- Division of Immunology-Allergy, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, QC, Canada
| | - Alexandra Mereniuk
- Division of Dermatology, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, QC, Canada
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4
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Kögel J, Berneburg M, Karrer S, Drexler K, Niebel D. [Multilocular pyoderma gangrenosum : Association with primary manifestation of primary biliary cholangitis]. Dermatologie (Heidelb) 2023:10.1007/s00105-023-05161-2. [PMID: 37326669 DOI: 10.1007/s00105-023-05161-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 06/17/2023]
Abstract
A 16-year-old female patient with previously diagnosed acne vulgaris was transferred to our clinic in reduced general condition with rapidly progressive and extremely painful ulcerations. In the laboratory exam, inflammatory parameters were highly elevated, but she was normothermic. Based on the findings, we diagnosed multilocular pyoderma gangrenosum. Further investigations established the diagnosis of primary biliary cholangitis as the underlying condition. Treatment with systemic corticosteroids was initiated and we started therapy with ursodeoxycholic acid. This led to improvement within a few days. PAPA-syndrome (pyogenic arthritis, pyoderma gangrenosum and acne vulgaris) could be ruled out by genetic analysis.
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Affiliation(s)
- Julian Kögel
- Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
| | - Mark Berneburg
- Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - Sigrid Karrer
- Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - Konstantin Drexler
- Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - Dennis Niebel
- Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
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5
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Song CY, Lu YQ. A man with fever and cogwheel-like dermal lesions. Intern Emerg Med 2022; 17:2423-2425. [PMID: 36087191 DOI: 10.1007/s11739-022-03094-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/01/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Cong-Ying Song
- Department of Emergency Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China
- Key Laboratory for Diagnosis and Treatment of Aging and Physic-Chemical Injury Diseases of Zhejiang Province, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Yuan-Qiang Lu
- Department of Emergency Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China.
- Key Laboratory for Diagnosis and Treatment of Aging and Physic-Chemical Injury Diseases of Zhejiang Province, Hangzhou, 310003, Zhejiang, People's Republic of China.
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6
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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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7
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Lee D, Baird D, Tarbox M. Multiple painful plaques and the Sweet's syndrome. Proc AMIA Symp 2022; 35:73-75. [PMID: 34970040 DOI: 10.1080/08998280.2021.1980307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
We present a rare case of Sweet's syndrome. A 39-year-old woman with subjective fevers, polyarthralgia, and malaise presented with worsening painful erythematous plaques on the trunk, arms, and legs. Further examination with biopsy revealed a diagnosis of acute febrile neutrophilic dermatosis, or Sweet's syndrome. Diagnosis by skin biopsy is crucial, and onset requires prompt evaluation for serious associated disorders such as leukemias, inflammatory bowel disease, thyroid disease, sarcoidosis, and infectious etiologies. In general, symptoms and cutaneous manifestations of Sweet syndrome respond rapidly to treatment with systemic corticosteroids or potassium iodide.
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Affiliation(s)
- Debra Lee
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Daniel Baird
- Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Michelle Tarbox
- Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock, Texas
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8
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Maglie R, Senatore S, Di Stefano G, Barzacchi M, Maio V, Montefusco F, Baffa ME, Bianchi B, Santucci M, Antiga E. Myelodysplasia cutis as the presenting sign of chronic myelomonocytic leukemia. Clin Exp Dermatol 2021; 47:773-775. [PMID: 34888907 DOI: 10.1111/ced.15055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 11/30/2021] [Accepted: 12/07/2021] [Indexed: 11/29/2022]
Affiliation(s)
- R Maglie
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - S Senatore
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - G Di Stefano
- Pathology Unit, Careggi University Hospital, Florence, Italy.,Department of Health Sciences, Section of Pathological Anatomy, University of Florence, Florence, Italy
| | - M Barzacchi
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - V Maio
- Pathology Unit, Careggi University Hospital, Florence, Italy.,Department of Health Sciences, Section of Pathological Anatomy, University of Florence, Florence, Italy
| | - F Montefusco
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - M E Baffa
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - B Bianchi
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - M Santucci
- Pathology Unit, Careggi University Hospital, Florence, Italy.,Department of Health Sciences, Section of Pathological Anatomy, University of Florence, Florence, Italy
| | - E Antiga
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
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9
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King D, Chandan JS, Thomas T, Nirantharakumar K, Reulen RC, Adderley NJ, Trudgill N. The Risk of Later Diagnosis of Inflammatory Bowel Disease in Patients With Dermatological Disorders Associated With Inflammatory Bowel Disease. Inflamm Bowel Dis 2021; 27:1731-1739. [PMID: 34669933 DOI: 10.1093/ibd/izaa344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Dermatological conditions such as erythema nodosum (EN), pyoderma gangrenosum, Sweet's syndrome, and aphthous stomatitis can occur with inflammatory bowel disease (IBD) and are considered dermatological extraintestinal manifestations (D-EIMs). Rarely, they may precede IBD. Other common conditions such as psoriasis have also been associated with IBD. This study examined the risk of a subsequent IBD diagnosis in patients presenting with a D-EIM. METHODS A retrospective cohort study compared patients with D-EIMs and age-/sex-matched patients without D-EIMs. Hazard ratios (HRs) were adjusted for age, sex, body mass index, deprivation, comorbidity, smoking, loperamide use, anemia, and lower gastrointestinal symptoms. Logistic regression was used to produce a prediction model for the diagnosis of IBD within 3 years of EN diagnosis. RESULTS We matched 7447 patients with D-EIMs (74% female; median age 38 years (interquartile ratio [IQR], 24-65 years) to 29,297 patients without D-EIMs. We observed 131 (1.8%) subsequent IBD diagnoses in patients with D-EIMs compared with 65 (0.2%) in those without D-EIMs. Median time to IBD diagnosis was 205 days (IQR, 44-661 days) in those with D-EIMs and 1594 days (IQR, 693-2841 days) in those without D-EIMs. The adjusted HR for a later diagnosis of IBD was 6.16 (95% confidence interval [CI], 4.53-8.37; P < 0.001), for ulcerative colitis the HR was 3.30 (95% CI, 1.98-5.53; P < 0.001), and for Crohn's disease the HR was 8.54 (95% CI, 5.74-12.70; P < 0.001). Patients with psoriasis had a 34% increased risk of a subsequent IBD diagnosis compared with the matched control patients (HR, 1.34; 95% CI, 1.20-1.51; P < 0.001). We included 4043 patients with an incident EN diagnosis in the prediction model cohort, with 87 patients (2.2%) diagnosed with IBD within 3 years. The model had a bias-corrected c-statistic of 0.82 (95% CI, 0.78-0.86). CONCLUSIONS Patients with D-EIMs have a 6-fold increased risk of a later diagnosis of IBD. Younger age, smoking, low body mass index, anemia, and lower gastrointestinal symptoms were associated with an increased risk of diagnosis of IBD within 3 years in patients with EN.
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Affiliation(s)
- Dominic King
- Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich, United Kingdom.,Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Joht Singh Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Tom Thomas
- Translational Gastroenterology Unit and Kennedy Institute of Rheumatology, University of Oxford, Oxford, United Kingdom
| | | | - Raoul C Reulen
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Nicola J Adderley
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Nigel Trudgill
- Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich, United Kingdom
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10
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Baffa ME, Maglie R, Giovannozzi N, Montefusco F, Senatore S, Massi D, Antiga E. Sweet Syndrome Following SARS-CoV2 Vaccination. Vaccines (Basel) 2021; 9:1212. [PMID: 34835143 DOI: 10.3390/vaccines9111212] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/16/2021] [Accepted: 10/16/2021] [Indexed: 01/14/2023] Open
Abstract
Vaccines are today considered one of the most effective means against the Sars-CoV-2 pandemic. The BNT162b2 vaccine by Pfizer/BioNTech has been massively administered throughout the globe; since its approval, a wide spectrum of cutaneous reactions has been reported. Here we report the case of a 52-year-old Caucasian male who presented with an acute febrile eruption that arose 72 h after the first dose of the BNT162b2 vaccine. The clinicopathological findings were consistent with Sweet's syndrome. The short latency time suggested a possible role of the vaccine in triggering Sweet's syndrome in this case.
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11
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Ramsey AL, Wallace WD, Abtin F, Suh JD, Liang LL, Shah S, Lynch JP 3rd, Belperio J, Derhovanessian A, Britton I, Sayah DM, Shino MY, Weigt SS, Saggar R. Sweet's Syndrome: A First in Human Lung Transplantation. Chest 2021; 160:e173-6. [PMID: 34366039 DOI: 10.1016/j.chest.2021.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 11/21/2022] Open
Abstract
Sweet’s Syndrome (SS), also known as acute febrile neutrophilic dermatosis, is one of several cutaneous inflammatory disorders classified as neutrophilic dermatoses. Respiratory complications are described in <50 cases in the literature,1 without prior report of lung transplantation (LT). This article explains the clinical course of the first patient to receive LT for pulmonary SS and presents evidence suggesting recurrence of the primary lung disease in the allograft.
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12
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Álvarez-Salafranca M, García-García M, de Escalante Yangüela B. Neutrophilic dermatosis of the dorsal hands related to cocaine abuse. An Bras Dermatol 2021; 96:574-577. [PMID: 34266687 PMCID: PMC8441522 DOI: 10.1016/j.abd.2020.07.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 07/24/2020] [Accepted: 07/31/2020] [Indexed: 11/27/2022] Open
Abstract
Neutrophilic dermatoses encompass a wide spectrum of diseases characterized by a dense infiltration mainly composed of neutrophils. Neutrophilic dermatosis of the dorsal hands is currently considered a localized variant of Sweet syndrome. Cocaine abuse has been related to a wide range of mucocutaneous manifestations, including neutrophilic dermatoses such as pyoderma gangrenosum. The authors of this study present a patient with neutrophilic dermatosis of the dorsal hands, in which cocaine abuse was identified as a probable trigger.
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Affiliation(s)
| | - Mar García-García
- Department of Pathology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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13
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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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14
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Abstract
Purpose: To report a case of a patient who suffered from Sweet's syndrome with panuveitis in both eyes.Materials & Methods: Retrospective interventional case report.Results: A 54-year-old Chinese male patient complained of fever, painful skin lesions and blurry vision in both eyes lasting for 4 days. His visual acuity was hand motion in both eyes. Slit-lamp examination showed the hypopyon and severe vitreous opacification in both eyes. A skin pathology from head skin lesion demonstrated diffuse neutrophilic infiltration in the dermis with karyorrhexis. Based on the inspection above, the patient was diagnosed with Sweet's syndrome and given systemic corticosteroids therapy. However, he developed secondary rhegmatogenous retinal detachment in the right eye during his treatment.Conclusion: The association of bilateral uveitis with Sweet's syndrome has been described in this report.
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Affiliation(s)
- Wenjuan Wang
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, Shandong, China.,Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
| | - Xin Wang
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Hongran Zhao
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, Shandong, China.,Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
| | - Yan Cui
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, Shandong, China
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15
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Yaşar HA, Akkus E, Heper A, Akay BN, Urun Y, Utkan G. Sweet's syndrome under ipilimumab therapy and a brief comparison of the cases in literature. J Oncol Pharm Pract 2020; 26:1762-1764. [PMID: 32089071 DOI: 10.1177/1078155220906885] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Ipilimumab is an anti-cytotoxic T lymphocyte antigen 4 (CTLA-4) antibody. Ipilimumab has shown improvement in overall survival in patients with advanced melanoma. Because ipilimumab activates the immune system against the tumor, ipilimumab is associated with adverse events related to immune system activation. Immune-associated side effects are frequently seen in the gastrointestinal system and skin. Sweet's syndrome (SS) is an uncommon inflammatory disorder. Some drugs or malignancy can cause SS. Only a few case reports have been reported of ipilimumab-associated SS. CASE A 53-year-old female with metastatic melanoma was treated with ipilimumab. After the fourth cycle, she developed painful lesions on her legs and hands. The pathologic biopsy of the lesions revealed neutrophilic dermatosis consistent with SS.Management and outcome: The patient was treated with 60 mg/day of prednisone for four days, nonsteroidal anti-inflammatory drugs and inhaler bronchodilator and steroid. She had symptomatic relief at the beginning of treatment. The prednisone doses were quickly tapered every three days. When the patient was treated with 10 mg/day of prednisone for three days, the skin nodules recurred. Prednisone 40 mg per day was re-started and then a slower taper by decreasing by 10 mg/day every week was instituted. After one-month treatment the prednisone dose was given as a 5 mg doses for one week and then stopped. No new lesions recurred after slower taper of prednisone. CONCLUSION Herein we report a case presented with SS under ipilimumab therapy. Melanoma patients treated with ipilimumab can develop SS. The clinicians should be aware of this condition.
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Affiliation(s)
- Hatime A Yaşar
- Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey
| | - Erman Akkus
- Department of Internal Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Aylin Heper
- Department of Pathology, Ankara University School of Medicine, Ankara, Turkey
| | - Bengu N Akay
- Department of Dermatology, Ankara University School of Medicine, Ankara, Turkey
| | - Yuksel Urun
- Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey
| | - Gungor Utkan
- Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey
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Cardoso D, Coelho A, Fernandes L, Matos LV, Serrano I, Miranda H, Martins A. Sweet's Syndrome Induced by Aromatase Inhibitor in the Treatment of Early Breast Cancer. Eur J Case Rep Intern Med 2020; 7:001435. [PMID: 32206641 PMCID: PMC7083188 DOI: 10.12890/2020_001435] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 12/31/2019] [Indexed: 11/29/2022] Open
Abstract
Background Breast cancer is the most commonly diagnosed cancer in women, mainly at an early stage, allowing treatment with curative intent. Aromatase inhibitors are widely used in the adjuvant treatment of oestrogen receptor-positive breast cancer, mainly in postmenopausal women. The most frequent adverse events associated with these therapies are musculoskeletal symptoms and an increased risk of bone fractures. Cutaneous adverse events have been rarely described. Sweet’s syndrome can present as an idiopathic disorder in addition to being malignancy-associated or drug-induced. Case presentation We report the case of a 69-year old woman, diagnosed with early stage breast cancer, who underwent breast-conserving surgery, followed by adjuvant radio and endocrine treatment with letrozole 2.5 mg daily, for a foreseeable duration of 5 years. Three months after starting letrozole, she presented with sudden fever and exuberant and painful erythematous skin papules and plaques on her upper body. After a full work-up and exclusion of other potential causes, a skin biopsy confirmed the presence of dermal oedema and a diffuse neutrophilic infiltrate, suggesting Sweet’s syndrome. After discontinuation of letrozole and treatment with corticosteroids, the patient fully recovered. She resumed adjuvant treatment with tamoxifen, without symptom recurrence. Conclusions Sweet’s syndrome is a rare condition and an association with aromatase inhibitors has not been previously reported. Although its occurrence has already been observed in the onset of malignancies such as breast cancer, aromatase inhibitors must be added to the list of potential causes of drug-induced Sweet’s syndrome. LEARNING POINTS
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Affiliation(s)
- Debora Cardoso
- Medical Oncology Department, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Andreia Coelho
- Medical Oncology Department, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Leonor Fernandes
- Medical Oncology Department, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Leonor Vasconcelos Matos
- Medical Oncology Department, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Isabel Serrano
- Pathology Department, Hospital de Cascais Dr. José Almeida, Cascais, Portugal
| | - Helena Miranda
- Medical Oncology Department, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Ana Martins
- Medical Oncology Department, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
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Wang W, Lu X, Li C, Ri MJ, Cui W. A man with recurrent fever, arthritis, and rashes-brucellosis? A case report. BMC Infect Dis 2020; 20:18. [PMID: 31910802 PMCID: PMC6947870 DOI: 10.1186/s12879-019-4746-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/28/2019] [Indexed: 12/17/2022] Open
Abstract
Background We report a rare case of chronic brucellosis accompanied with myelodysplastic syndrome and neutrophilic dermatosis, which to the best of our knowledge, has never been reported. Case presentation A young man was admitted to our hospital complaining of recurrent fever, arthritis, rashes and anemia. He had been diagnosed with brucellosis 6 years prior and treated with multiple courses of antibiotics. He was diagnosed with myelodysplastic syndrome and neutrophilic dermatosis following bone marrow puncture and skin biopsy. After anti-brucellosis treatment and glucocorticoid therapy, the symptoms improved. Conclusions Clinicians should consider noninfectious diseases when a patient who has been diagnosed with an infectious disease exhibits changing symptoms.
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Affiliation(s)
- Wen Wang
- Department of Infectious Diseases, The First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Shenyang, 110001, Liaoning Province, China.
| | - Xu Lu
- Department of Infectious Diseases, The First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Shenyang, 110001, Liaoning Province, China
| | - Chengbo Li
- Department of Infectious Diseases, The First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Shenyang, 110001, Liaoning Province, China
| | - Myong Jun Ri
- Department of Infectious Diseases, Clinical Faculty Number 1, Kim Il Song University Pyongyang Medical College, Pyongyang, Democratic People's Republic of Korea
| | - Wei Cui
- Department of Infectious Diseases, The First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Shenyang, 110001, Liaoning Province, China.
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Affiliation(s)
- Takuya Suyama
- Hematology and Oncology Division, Hitachi General Hospital, 2-1-1 Jonancho, Hitachi, Ibaraki, 317-0077, Japan.
| | - Syusaku Ito
- Dermatology Division, Hitachi General Hospital, Hitachi, Ibaraki, Japan
| | - Atsushi Shinagawa
- Hematology and Oncology Division, Hitachi General Hospital, 2-1-1 Jonancho, Hitachi, Ibaraki, 317-0077, Japan
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Manzo C, Pollio N, Natale M. Sweet's Syndrome Following Therapy with Hydroxychloroquine in a Patient Affected with Elderly-Onset Primary Sjogren's Syndrome. Medicines (Basel) 2019; 6:E111. [PMID: 31731586 DOI: 10.3390/medicines6040111] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 11/12/2019] [Accepted: 11/13/2019] [Indexed: 01/22/2023]
Abstract
Sweet's syndrome is an uncommon skin disease characterized by painful polymorphic lesions associated with fever and neutrophilia. When biopsied, these lesions reveal a diffuse infiltrate of mature neutrophils in the papillary dermis. Several drugs can induce Sweet's syndrome (so-called drug-induced Sweet's syndrome (DISS)) but reports of DISS associated with hydroxychloroquine (HCQ) are exceptionally limited. A 72-year-old Caucasian female patient with elderly-onset primary Sjogren's syndrome (EOpSS) but low disease activity presented with an abrupt onset of painful nodular and papular erythematous skin lesions after two weeks of therapy with HCQ 400 mg. A histological examination revealed a diffuse infiltrate of mature neutrophils in the papillary dermis, without vasculitis. After therapy with 25 mg/day prednisone and HCQ withdrawal, the cutaneous manifestations disappeared. When prednisone was permanently discontinued, the primary Sjogren's syndrome (pSS) manifestations worsened and therapy with HCQ 200 mg was reintroduced. In a few days, the same skin lesions reappeared. Withdrawal of HCQ and a new cycle of prednisone resulted in their permanent disappearance. We reported a case of DISS following therapy with HCQ in a female patient affected by EOpSS. According to a literature review, this is the first report of this association.
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Su SS, Zhang SN, Ye JR, Xu LN, Lin PC, Xu HY, Wu Q, Li YP. Disseminated Talaromyces marneffei And Mycobacterium avium Infection Accompanied Sweet's Syndrome In A Patient With Anti-Interferon-γ Autoantibodies: A Case Report. Infect Drug Resist 2019; 12:3189-3195. [PMID: 31632104 PMCID: PMC6791407 DOI: 10.2147/idr.s218836] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 09/18/2019] [Indexed: 12/22/2022] Open
Abstract
Background Patients with high-titer anti-IFN-γ autoantibodies present disseminated non-tuberculous mycobacterial (NTM) and other opportunistic infections. Due to its rare occurrence and non-specific symptoms, this syndrome is difficult to diagnose during early disease stages. Here, we report a case with high-concentrations of serum anti-IFN-γ autoantibodies who presented with disseminated Talaromyces marneffei and NTM disease accompanied Sweet’s syndrome. Case presentation A 62-year-old Chinese woman with no previous history was admitted to our hospital in August 2016 due to intermittent fever for 2 years, left chest wall redness, and swelling for 3 months. During hospitalization, the patient was confirmed with disseminated T. marneffei and successfully treated with antifungal therapy. In July 2017, upon second admission, Mycobacterium avium intracellular (MAC) pulmonary infection was established after positive cultures from the right lung tissue. The patient failed treatment after 1 month of anti-NTM therapy due to side effects. In May 2018, she was confirmed as having disseminated MAC disease accompanied by hand rashes, which was considered as Sweet’s syndrome. High-level anti-IFN-γ antibodies in the patient serum were detected upon comparison with normal controls (2.85-fold increase). Following anti-NTM therapy, both symptoms and pulmonary infiltration gradually improved, and joint destruction and lymphadenitis remained. Conclusions Patients with anti-interferon-γ autoantibodies should be considered for severe, recurrent infections in adults in the absence of other known risk factors. Sweet’s syndrome is a common skin manifestation of the syndrome.
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Affiliation(s)
- Shan-Shan Su
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325015, People's Republic of China
| | - Sheng-Nan Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325015, People's Republic of China
| | - Jun-Ru Ye
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325015, People's Republic of China
| | - Ling-Na Xu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325015, People's Republic of China
| | - Peng-Cheng Lin
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325015, People's Republic of China
| | - Han-Yan Xu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325015, People's Republic of China
| | - Qing Wu
- The Center of Laboratory and Diagnosis, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325015, People's Republic of China
| | - Yu-Ping Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325015, People's Republic of China
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21
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Abstract
The correct interpretation of skin manifestations can facilitate the diagnosis of many rare systemic diseases. Such manifestations can be due to autoimmune diseases (e.g. dermatomyositis, systemic lupus erythematosus, systemic sclerosis and sarcoidosis) and metabolic diseases (e.g. Anderson-Fabry disease and porphyria cutanea tarda). Other cutaneous symptoms are of great importance because they are possible warning signs of occult diseases of internal organs. This is true for example for some diseases from the group of neutrophilic dermatoses, such as Sweet's syndrome and pyoderma gangraenosum.
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Affiliation(s)
- Bruno Gualtieri
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Marburg (UKGM), Baldingerstr. 1, 35043, Marburg, Deutschland.
| | - Michael Hertl
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Marburg (UKGM), Baldingerstr. 1, 35043, Marburg, Deutschland
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22
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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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Cook QS, Zdanski CJ, Burkhart CN, Googe PB, Thompson P, Wu EY. Idiopathic, Refractory Sweet's Syndrome Associated with Common Variable Immunodeficiency: a Case Report and Literature Review. Curr Allergy Asthma Rep 2019; 19:32. [PMID: 31089823 DOI: 10.1007/s11882-019-0864-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE OF REVIEW Sweet's syndrome (SS) is classically considered a hypersensitivity reaction often associated with autoimmune disorders and malignancy. SS has also been increasingly reported to occur with immunodeficiencies. We present a case of treatment-refractory, systemic SS as the initial manifestation in a young child with common variable immunodeficiency (CVID). We also review current literature about SS and concurrent immunodeficiencies and autoimmunity in CVID patients. RECENT FINDINGS Few case reports exist regarding the co-occurrence of Sweet's syndrome and primary immunodeficiencies. SS is characterized by a pro-inflammatory state with a neutrophil predominance resulting in a spectrum of clinical manifestations. CVID is a multifactorial antibody deficiency that can be associated with autoimmunity, which some studies have proposed to be secondary to altered CD21 expression. SS occurring in patients with CVID has been infrequently reported, and one case study demonstrated improvement of Sweet's associated skin lesions with immunoglobulin replacement. In our case, the patient had multi-system SS refractory to multiple immunomodulatory therapies. To our knowledge, this is the first report of the effective and safe use of intravenous tocilizumab and oral lenalidomide to treat SS in a child with CVID. Immunoglobulin replacement reduced the frequency of infections and may have contributed to the opportunity to wean the immunosuppressive therapies for Sweet's syndrome. Sweet's syndrome as an initial manifestation of co-occurring immunodeficiencies is rare, and providers need a high index of suspicion. In addition, treatment of SS associated with an immunodeficiency can be a challenge. Treatment with immunoglobulin replacement reduces the frequency of infections, and in some patients with concurrent SS may improve skin lesions and reduce the need for immunomodulator therapy. Further study is necessary to better understand the pathogenesis of CVID in patients with SS and to identify possible biomarkers that predict who with SS are at risk for developing hypogammaglobulinemia.
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Affiliation(s)
- Quindelyn S Cook
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of North Carolina at Chapel Hill, 3300 Thurston Building, CB 7280, Chapel Hill, NC, 27599-7280, USA.
| | - Carlton J Zdanski
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Craig N Burkhart
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Paul B Googe
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Patrick Thompson
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Eveline Y Wu
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of North Carolina at Chapel Hill, 3300 Thurston Building, CB 7280, Chapel Hill, NC, 27599-7280, USA
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24
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Smolovic BD, Gajic-Veljic MD, Nikolic MM, Muhovic DF. Pregnancy-Induced Sweet's Syndrome Treated with Infliximab. Med Princ Pract 2019; 28:196-198. [PMID: 30376667 PMCID: PMC6545913 DOI: 10.1159/000494974] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 10/30/2018] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To present a case of relapsing and resistant Sweet's syndrome that developed during pregnancy together with an onset of Crohn's disease, showing complete resolution with the use of infliximab. CLINICAL PRESENTATION AND INTERVENTION A 30-year-old pregnant woman presented with fever, skin lesions, and diarrhea. Skin biopsy confirmed neutrophilic dermatosis and she was diagnosed with Crohn's disease after endoscopy. There was no recurrence of Sweet's syndrome outside of her pregnancy. During a previous pregnancy, while corticosteroids were ineffective, complete regression of skin lesions was achieved using infliximab. CONCLUSION The "off-label" use of infliximab is beneficial for relapsing and resistant Sweet's syndrome.
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Affiliation(s)
- Brigita D Smolovic
- Department of Gastroenterohepatology, Clinical Center of Montenegro, Faculty of Medicine, University of Montenegro, Podgorica, Montenegro,
| | - Mirjana D Gajic-Veljic
- Department of Dermatovenereology, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Milos M Nikolic
- Department of Dermatovenereology, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Damir F Muhovic
- Department of Gastroenterohepatology, Clinical Center of Montenegro, Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
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25
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Silfvast-Kaiser A, Napoli E, Stockton L, Bautista I, Lopez L, Mirkes C. Sweet's syndrome in a patient with Crohn's disease. Proc (Bayl Univ Med Cent) 2018; 31:460-461. [PMID: 30948979 DOI: 10.1080/08998280.2018.1496670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/28/2018] [Accepted: 07/02/2018] [Indexed: 01/27/2023] Open
Abstract
Sweet's syndrome, or acute febrile neutrophilic dermatosis, has previously been associated with underlying inflammatory bowel disease; however, there are fewer than 50 case reports of such an association. Herein, we describe a young woman with Crohn's disease who presented with abrupt onset of a painful, tender erythematous rash on the dorsal hands and face.
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Affiliation(s)
| | | | - Lindsey Stockton
- Department of Internal Medicine, Baylor Scott & White HealthTempleTexas
| | - Ira Bautista
- Department of Internal Medicine, Baylor Scott & White HealthTempleTexas
| | - Lisa Lopez
- Department of Anatomic Pathology, Baylor Scott & White HealthTempleTexas
| | - Curtis Mirkes
- Department of Internal Medicine, Baylor Scott & White HealthTempleTexas
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26
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Lee JH, Kim KB, Lee JR, Chung MJ, Wang SI. Sweet's syndrome: a clinical entity need to discriminate against acute haematogenous periprosthetic joint infection. Knee Surg Sports Traumatol Arthrosc 2018; 26:2692-2696. [PMID: 28875344 DOI: 10.1007/s00167-017-4705-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 08/30/2017] [Indexed: 11/26/2022]
Abstract
Sweet's syndrome (SS) or acute febrile neutrophilic dermatosis is an uncommon condition. It is characterized by fever, polymorphonuclear leukocytosis, painful erythematous cutaneous plaques, and dense dermal infiltrate of neutrophils without vasculitis at the site of skin lesions. Lesions in SS might enlarge and coalesce with increasing dermal oedema, resulting in pseudo-vesicular appearance mimicking joint infections. Here, a rare case of SS mimicking acute haematogenous periprosthetic infection in a 74-year-old woman with a history of total knee arthroplasty is reported. This report aims to elaborate clinical various manifestations of SS in a patient with a history of total knee arthroplasty. In addition, this report describes how to discriminate inflammation between SS and periprosthetic joint infection. Level of evidence V.
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Affiliation(s)
- Ju Hong Lee
- Department of Orthopaedics Surgery, Chonbuk National University Medical School, Research Institute for Endocrine Sciences, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, 567 Baekje-ro, Dukjin-gu, Jeonju, 561-756, Republic of Korea
| | - Ki Bum Kim
- Department of Orthopaedics Surgery, Chonbuk National University Medical School, Research Institute for Endocrine Sciences, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, 567 Baekje-ro, Dukjin-gu, Jeonju, 561-756, Republic of Korea
| | - Ju Rang Lee
- Department of Orthopaedics Surgery, Chonbuk National University Medical School, Research Institute for Endocrine Sciences, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, 567 Baekje-ro, Dukjin-gu, Jeonju, 561-756, Republic of Korea
| | - Myougn Ja Chung
- Department of Pathology, Chonbuk National University Medical School, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, 567 Baekje-ro, Dukjin-gu, Jeonju, 561-756, Republic of Korea
| | - Sung Il Wang
- Department of Orthopaedics Surgery, Chonbuk National University Medical School, Research Institute for Endocrine Sciences, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, 567 Baekje-ro, Dukjin-gu, Jeonju, 561-756, Republic of Korea.
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27
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Zhu T, Zhao WL, Zeng YP, Liu YH, Jin HZ, Li L. Systemic sclerosis-rheumatoid arthritis overlap syndrome complicated with Sweet's syndrome. Clin Rheumatol 2018; 37:2281-2284. [PMID: 29802482 DOI: 10.1007/s10067-018-4150-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/27/2018] [Accepted: 05/15/2018] [Indexed: 11/24/2022]
Abstract
Herein, we report a case of a 34-year-old woman with systemic sclerosis (SSc)-rheumatoid arthritis (RA) overlap syndrome (OS) complicated with Sweet's syndrome. OS has been defined as entities satisfying classification criteria of at least two connective tissue diseases (CTD) occurring at the same or at different times in the same patient. The CTD include RA, SSc, systemic lupus erythematosus (SLE), polymyositis, and dermatomyositis. Sweet's syndrome also known as acute febrile neutrophilic dermatosis was first described by Robert Sweet in 1964. Sweet's syndrome is characterized by fever, neutrophilia, erythematous skin lesions, and a diffuse dermal infiltrate of mature neutrophils. There are sets of associations that we will discuss in this article between OS and Sweet's syndrome.
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Affiliation(s)
- T Zhu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuai Fu Yuan No.1, Dongcheng District, Beijing, 100730, China
| | - W L Zhao
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuai Fu Yuan No.1, Dongcheng District, Beijing, 100730, China
| | - Y P Zeng
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuai Fu Yuan No.1, Dongcheng District, Beijing, 100730, China
| | - Y H Liu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuai Fu Yuan No.1, Dongcheng District, Beijing, 100730, China
| | - H Z Jin
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuai Fu Yuan No.1, Dongcheng District, Beijing, 100730, China
| | - L Li
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuai Fu Yuan No.1, Dongcheng District, Beijing, 100730, China.
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Affiliation(s)
- Vivian Tien
- Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA
| | - Andrew D Jones
- Department of Pathology, University of California, Davis, Sacramento, CA, USA
| | - Paul B Aronowitz
- Department of Internal Medicine, UC Davis Medical Center, University of California, Davis, 4150 V Street Suite 1100, Sacramento, CA, 95817, USA.
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Takano Y, Fujino H, Yachie A, Sumimoto SI. Serum cytokine profile in pediatric Sweet's syndrome: a case report. J Med Case Rep 2017; 11:178. [PMID: 28668093 PMCID: PMC5494139 DOI: 10.1186/s13256-017-1317-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 05/10/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Sweet's syndrome is characterized by fever, leukocytosis, and tender erythematous papules or nodules. It is a rare condition, particularly in the pediatric population, and has recently been proposed to be an autoinflammatory disease that occurs due to innate immune system dysfunction, involving several cytokines, which causes abnormally increased inflammation. To the best of our knowledge, no report has documented the cytokine profile in a pediatric patient with Sweet's syndrome. CASE PRESENTATION A previously healthy 34-month-old Japanese girl was hospitalized because of remittent fever and pain in her right lower extremity with erythematous nodules. A skin biopsy of the eruption revealed dermal perivascular neutrophilic infiltration with no evidence of vasculitis, which led to the diagnosis of Sweet's syndrome. She was prescribed with orally administered prednisolone and a prompt response was observed; then, the prednisolone dose was tapered. During treatment she developed upper and lower urinary tract infections, after which her cutaneous symptoms failed to improve despite increasing the prednisolone dosage. To avoid long-term use of systemic corticosteroids, orally administered potassium iodide was initiated, but it was unsuccessful. However, orally administered colchicine along with prednisolone effectively ameliorated her symptoms, and prednisolone dosage was reduced again. We analyzed the circulating levels of interleukin-1β, interleukin-6, interleukin-18, neopterin, and soluble tumor necrosis factor receptors I and II, in order to clarify the pathogenesis of Sweet's syndrome. Of these cytokines, only interleukin-6 levels were elevated prior to orally administered prednisolone therapy. Following therapy, the elevated interleukin-6 levels gradually diminished to almost normal levels; interleukin-1β and interleukin-18 stayed within normal ranges throughout the treatment. Neopterin became marginally elevated after the start of treatment. Both soluble tumor necrosis factor receptor I and soluble tumor necrosis factor receptor II levels increased shortly after the onset of urinary tract infections. CONCLUSIONS This is the first case report of pediatric Sweet's syndrome in which serum cytokine levels were investigated. Future studies should gather more evidence to elucidate the pathophysiology of Sweet's syndrome.
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Affiliation(s)
- Yoshihiko Takano
- Department of Pediatrics, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan.
| | - Hisanori Fujino
- Department of Pediatrics, Osaka Red Cross Hospital, 5-30 Fudegasaki-Cho, Tennouji-Ku, Osaka, 543-8555, Japan
| | - Akihiro Yachie
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical, and Health Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Shin-Ichi Sumimoto
- Department of Pediatrics, Osaka Red Cross Hospital, 5-30 Fudegasaki-Cho, Tennouji-Ku, Osaka, 543-8555, Japan
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30
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Hart A, Plenk K, Carr D. Sweet syndrome presenting as a febrile rash in a returning traveller. CAN J EMERG MED 2018; 20:476-8. [PMID: 28534449 DOI: 10.1017/cem.2017.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Sweet syndrome was discovered in 1964 and is now well described in the dermatology literature. Knowledge of this unique febrile and painful dermatosis is important for the emergency physician because the syndrome can be readily identified and is extremely responsive to oral steroid therapy. Early diagnosis can greatly improve patient satisfaction and avoid days of ineffective treatment. An accurate and timely diagnosis of Sweet syndrome is also important to guide investigation into a number of associated diseases.
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Kechaou I, Cherif E, Boukhris I, Azzabi S, Ben Hassine L. [Refractory Sweet syndrome complicated by monoclonal gammopathy of undetermined significance]. Rev Med Brux 2017; 38:152-153. [PMID: 28653516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The association between Sweet syndrome and monoclonal gammopathy of undetermined significance (MGUS) is exceptional. We report the case of a 44 years-old woman in whom recurrent Sweet syndrome was complicated by monoclonal gammopathy of undetermined significance (MGUS) after 3 years of evolution.
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Affiliation(s)
- I Kechaou
- Service de Médecine interne B, Hôpital Charles-Nicolle, Tunis, Tunisie
| | - E Cherif
- Service de Médecine interne B, Hôpital Charles-Nicolle, Tunis, Tunisie
| | - I Boukhris
- Service de Médecine interne B, Hôpital Charles-Nicolle, Tunis, Tunisie
| | - S Azzabi
- Service de Médecine interne B, Hôpital Charles-Nicolle, Tunis, Tunisie
| | - L Ben Hassine
- Service de Médecine interne B, Hôpital Charles-Nicolle, Tunis, Tunisie
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Yaghmour G, Wiedower E, Yaghmour B, Nunnery S, Duncavage E, Martin MG. Sweet's syndrome associated with clonal hematopoiesis of indeterminate potential responsive to 5-azacitidine. Ther Adv Hematol 2016; 8:91-95. [PMID: 28203345 DOI: 10.1177/2040620716680330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Sweet's syndrome (SS) is a rare condition characterized by the abrupt appearance of painful skin lesions due to neutrophilic dermal infiltration. Hematologic neoplasms, particularly acute myeloid leukemia (AML) and myelodysplastic syndromes (MDSs), have been commonly reported in association with SS. Clonal hematopoiesis of indeterminate potential (CHIP) is an emerging entity that is a precursor state to myeloid neoplasms. CHIP has not been previously associated with SS. We report the case of a 71-year-old man who presented with recurrent, painful edematous and erythematous papules and nodules for 18 months despite treatment with corticosteroids. He had normal blood counts, but a macrocytosis was noted (110 fl). Alternative causes of macrocytosis were ruled out. A skin biopsy confirmed a diagnosis of SS. Bone marrow biopsy specimen yielded a normal karyotype except for loss of the Y chromosome and equivocal morphologic findings. Polymerase chain reaction (PCR) and reverse transcription polymerase chain reaction (RT-PCR) of selected genes from the peripheral blood demonstrated a mixed lineage leukemia (MLL) partial tandem duplication (PTD) and sequence variant in CCAAT/enhancer binding protein alpha (CEBPA). These findings were consistent with a diagnosis of CHIP. The patient was treated with 5-azacitidine and achieved a complete remission of his skin lesions and was able to discontinue corticosteroids. To our knowledge, this is the first report of a patient with recurrent SS associated with CHIP. In addition to other myeloid neoplasms like AML and MDS, CHIP should be considered as a potential etiology in cases of recurrent SS. Treatment with a hypomethylating agents such as azacitidine could also serve as an alternative to systemic corticosteroid therapy.
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Affiliation(s)
- George Yaghmour
- Department of Hematology and Oncology, Keck Hospital of USC, USC Norris Cancer Hospital, 1441 Eastlake Avenue, NTT suite 3467, Los Angeles, CA 90033-458, USA
| | - Eric Wiedower
- Department of Hematology/Oncology, The West Clinic, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Bassam Yaghmour
- Department of Pulmonary and Critical Care, Keck Hospital of USC, Los Angeles, CA, USA
| | - Sara Nunnery
- Department if Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Eric Duncavage
- Department of Pathology and Immunology Division of Anatomic and Molecular Pathology, Washington University in St. Louis, St. Louis, MO, USA
| | - Mike G Martin
- Department of Hematology/Oncology, The West Clinic, The University of Tennessee Health Science Center, Memphis, TN, USA
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Wlodek C, Bhatt N, Kennedy C. Two neutrophilic dermatoses captured simultaneously on histology. Dermatol Pract Concept 2016; 6:55-7. [PMID: 27648385 PMCID: PMC5006554 DOI: 10.5826/dpc.0603a11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 05/27/2016] [Indexed: 12/14/2022] Open
Abstract
A number of neutrophilic dermatoses are associated with malignancies and their treatment. These rarely occur together in the same patient. A Caucasian 72-year-old male was treated for acute myeloid leukemia (AML) with chemotherapy including daunorubicin and cytarabine. Within 48 hours of commencing treatment, he developed pyrexia and, two days later, disseminated non-tender pink plaques on the limbs and trunk. A skin biopsy showed a dermal interstitial infiltrate of lymphocytes, histiocytoid cells and predominantly neutrophils. This extended into the subcutis, where a neutrophilic lobular panniculitis was seen. These findings are consistent with Sweet’s syndrome. In addition, a neutrophilic and lymphocytic infiltrate was also present around eccrine coils and lower ducts. The eccrine epithelium showed squamous metaplasia with dyskeratosis and sloughing into the lumen. These latter findings are consistent with neutrophilic eccrine hidradenitis (NEH). These two histologically distinct entities form part of the neutrophilic dermatoses that have been described in oncology patients with reports of concurrent or sequential occurrence of various neutrophilic dermatoses in the same patient. Ours, however, is only the second reported case of simultaneously captured Sweet’s and NEH in the setting of AML. The most likely explanation is that of an epiphenomenon, whereby the neutrophilic infiltrate extended around the sweat glands in the context of the neutrophilic dermatosis.
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Affiliation(s)
| | - Nidhi Bhatt
- Department of Pathology, Bristol Royal Infirmary, Bristol, UK
| | - Cameron Kennedy
- Department of Dermatology, Bristol Royal Infirmary, Bristol, UK
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Shinozuka J, Tomiyama H, Tanaka SI, Tahara J, Awaguni H, Makino S, Maruyama R, Imashuku S. Neonatal Sweet's Syndrome Associated with Rectovestibular Fistula with Normal Anus. Pediatr Rep 2015; 7:5858. [PMID: 26266031 PMCID: PMC4508622 DOI: 10.4081/pr.2015.5858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 05/25/2015] [Accepted: 05/25/2015] [Indexed: 11/23/2022] Open
Abstract
Sweet's syndrome, characterized by fever and a painful erythematous rash with a dermal neutrophilic infiltrate, develops primarily due to paraneoplastic phenomena in adults. Sweet's syndrome is very rare in neonates. We report a Japanese female neonate (age <2 months), who developed Sweet's syndrome with episodes of perineal infection in association with congenital rectovestibular fistula with normal anus. Sweet's syndrome was diagnosed basing on clinical features and histopathology of biopsied skin tissues. Rectovestibular fistula was confirmed after the signs of inflammation subsided and the rash disappeared. In the literature, we found another case of neonatal Sweet's syndrome associated with rectovestibular fistula in a Japanese female neonate. The perineal region should be screened for anomalies following diagnosis of Sweet's syndrome in neonates.
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Affiliation(s)
- Jun Shinozuka
- Division of Pediatrics, Uji-Tokushukai Medical Center , Uji, Kyoto, Japan
| | - Hideki Tomiyama
- Division of Pediatric Surgery, Uji-Tokushukai Medical Center , Uji, Kyoto, Japan
| | - Shin-Ichiro Tanaka
- Division of Pediatrics, Uji-Tokushukai Medical Center , Uji, Kyoto, Japan
| | - Junko Tahara
- Division of Pediatrics, Uji-Tokushukai Medical Center , Uji, Kyoto, Japan
| | - Hitoshi Awaguni
- Division of Pediatrics, Uji-Tokushukai Medical Center , Uji, Kyoto, Japan
| | - Shigeru Makino
- Division of Pediatrics, Uji-Tokushukai Medical Center , Uji, Kyoto, Japan
| | - Rikken Maruyama
- Division of Pediatrics, Uji-Tokushukai Medical Center , Uji, Kyoto, Japan
| | - Shinsaku Imashuku
- Division of Laboratory Medicine, Uji-Tokushukai Medical Center , Uji, Kyoto, Japan
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Kaya Z, Belen FB, Akyürek N. Granulocyte Colony Stimulating Factor Induced Sweet's Syndrome Following Autologous Transplantation in a Child with Relapsed Acute Myeloblastic Leukemia. Indian J Hematol Blood Transfus 2014; 30:376-8. [PMID: 25332624 DOI: 10.1007/s12288-014-0420-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 06/02/2014] [Indexed: 11/30/2022] Open
Abstract
Sweet's syndrome is characterized by the triad of fever, erythematous skin lesions and neutrophilia. The etiologic factors are quite variable, and granulocyte colony-stimulating factor (G-CSF) use is an extremely rare cause in children with Sweet's syndrome. We report a G-CSF induced Sweet's syndrome following autologous transplantation in a child with relapsed acute myeloblastic leukemia.
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Affiliation(s)
- Zühre Kaya
- The Pediatric Hematology Unit of the Department of Pediatrics, Medical School of Gazi University, Beşevler, Ankara, 06500 Turkey
| | - Fatma Burcu Belen
- The Pediatric Hematology Unit of the Department of Pediatrics, Medical School of Gazi University, Beşevler, Ankara, 06500 Turkey
| | - Nalan Akyürek
- Department of Pathology, Medical School of Gazi University, Beşevler, Ankara, 06500 Turkey
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Abstract
Pacemaker infections can be difficult to diagnose, especially when they present with non-specific symptoms and signs a long time after insertion of the device. Unidentified or partially treated low-grade chronic sepsis can result in multisystem disease processes with significant mortality and morbidity. Therefore, a high index of suspicion is required to identify the pacemaker as the source of sepsis and treat it effectively. This report describes a case of chronic pacemaker wire infection, which eventually presented with Sweet's syndrome, a rare manifestation of infective endocarditis.
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Affiliation(s)
- I Merinopoulos
- I Merinopoulos, Department of Cardiology, Papworth Hospital, Cambridge CB23 3RE, UK. Email
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Asano T, Fujii N, Niiya D, Nishimori H, Fujii K, Matsuoka KI, Ichimura K, Hamada T, Kondo E, Maeda Y, Tanimoto Y, Shinagawa K, Tanimoto M. Complete resolution of steroid-resistant organizing pneumonia associated with myelodysplastic syndrome following allogeneic hematopoietic cell transplantation. Springerplus 2014; 3:3. [PMID: 25140286 PMCID: PMC4137417 DOI: 10.1186/2193-1801-3-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 12/30/2013] [Indexed: 11/24/2022]
Abstract
Pulmonary complications in patients with hematological malignancies are often caused by infection but are sometimes associated with an underlying disease such as organizing pneumonia (OP). Here, we report a case of life-threatening steroid-resistant OP associated with myelodysplastic syndrome (MDS) and successfully performed allogeneic hematopoietic cell transplantation (HSCT). A 33-year-old female with refractory anemia with excess blasts-1 that had progressed from refractory anemia with ringed sideroblasts and concomitant Sweet’s syndrome was admitted. Multiple pulmonary infiltrates were revealed on a chest computed tomography scan, which progressively worsened even after chemotherapy and corticosteroid therapy. No evidence of infection was observed in bronchoalveolar lavage fluid. A histological examination of a transbronchial lung biopsy specimen showed lymphocyte invasion with fibrosis, indicating that the pulmonary infiltrates were OP associated with MDS. Before transplantation, she suffered from respiratory failure and required oxygen supplementation. She developed idiopathic pneumonitis syndrome on day 61 that responded well to corticosteroid therapy, and the OP pulmonary infiltrates improved gradually after HSCT, She was discharged on day 104 and is well without recurrence of OP or MDS 2 years after HSCT.
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Affiliation(s)
- Takeru Asano
- Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Hospital, Okayama, Japan
| | - Nobuharu Fujii
- Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Hospital, Okayama, Japan ; Division of Transfusion, Okayama University Hospital, Okayama, Japan
| | - Daigo Niiya
- Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Hospital, Okayama, Japan
| | - Hisakazu Nishimori
- Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Hospital, Okayama, Japan ; Division of Transfusion, Okayama University Hospital, Okayama, Japan
| | - Keiko Fujii
- Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Hospital, Okayama, Japan ; Division of Transfusion, Okayama University Hospital, Okayama, Japan
| | - Ken-Ichi Matsuoka
- Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Hospital, Okayama, Japan
| | - Koichi Ichimura
- Department of Pathology, Okayama University Hospital, Okayama, Japan
| | - Toshihisa Hamada
- Department of Dermatology, Okayama University Hospital, Okayama, Japan
| | - Eisei Kondo
- Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Hospital, Okayama, Japan
| | - Yoshinobu Maeda
- Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Hospital, Okayama, Japan
| | - Yasushi Tanimoto
- Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Hospital, Okayama, Japan
| | - Katsuji Shinagawa
- Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Hospital, Okayama, Japan
| | - Mitsune Tanimoto
- Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Hospital, Okayama, Japan
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