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Bechtold A, Owczarczyk‐Saczonek A. Atypical presentation of Sweet syndrome with nodular erythema and oral ulcerations provoked by Ad26.COV2.S SARS-CoV-2 vaccination and review of literature. Dermatol Ther 2022; 35:e15923. [PMID: 36219526 PMCID: PMC9874627 DOI: 10.1111/dth.15923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/05/2022] [Accepted: 10/08/2022] [Indexed: 01/27/2023]
Abstract
The aim of this article is to present the case of acute febrile neutrophilic dermatosis (Sweet syndrome-SS) after Ad26.COV2.S vaccination against SARS-CoV-2. To the best of our knowledge, this is the second case of SS provoked by this specific vaccine. What is more, the mildly symptomatic beginning of the disease, later followed by typical SS manifestation with a variety of symptoms including nodular erythema of the feet and oral ulcerations, made it very challenging to establish the diagnosis. The article focuses on the current literature on the acute febrile neutrophilic dermatosis, along with the coexistence with other neutrophilic dermatoses and anti-SARS-CoV-2 vaccinations as provoking factors. It emphasizes the necessity for sharing the knowledge and experience on the subject of SS's clinical manifestations and underlying causes to facilitate prompt diagnosis and introduction of appropriate treatment.
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Affiliation(s)
- Agata Bechtold
- Dermatology, Sexually Transmitted Diseases and Clinical Immunology ClinicThe Municipal Polyclinical Hospital in OlsztynOlsztynPoland
- Department of Psychodermatology, Department of Pulmonology, Rheumatology and Clinical ImmunologyMedical University of LodzLodzPoland
| | - Agnieszka Owczarczyk‐Saczonek
- Department and Clinic of Dermatology, Sexually Transmitted Diseases and Clinical ImmunologyUniveristy of Warmia and Mazury in OlsztynOlsztynPoland
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Berger DMS, Schaeffers AWMA, van Dijk MR, Kamalski DMA. Diagnosis of Sweet's syndrome in otolaryngology. BMJ Case Rep 2021; 14:e242262. [PMID: 34521737 PMCID: PMC8442057 DOI: 10.1136/bcr-2021-242262] [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] [Accepted: 08/24/2021] [Indexed: 11/03/2022] Open
Abstract
Sweet's syndrome (acute febrile neutrophilic dermatosis) consists of acute onset of painful cutaneous erythematous lesions, mostly found in the upper extremities followed by the head and neck region, particularly in patients with underlying malignancies. We describe the case of a woman in her mid-30s, who was treated for acute myeloid leukaemia and presented with a severe painful and progressive erythematous lesion of the retroauricular skin. Clinical features, laboratory tests, blood cultures and histological biopsy yielded a diagnosis of Sweet's syndrome. The treatment consisted of oral and topical corticosteroids and her signs and symptoms resolved within 1 week. Although Sweet's syndrome is uncommon, awareness among otolaryngologists is crucial to ensure a prompt diagnosis, cure and referral to an oncologist (if not already involved) for patients with Sweet's syndrome in the head and neck area.
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Affiliation(s)
- Danique M S Berger
- Otorhinolaryngology and Head & Neck Surgery, UMC Utrecht, Utrecht, The Netherlands
| | | | | | - Digna M A Kamalski
- Otorhinolaryngology and Head & Neck Surgery, UMC Utrecht, Utrecht, The Netherlands
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Sardiña LA, Jour G, Piliang MP, Bergfeld WF. Erythema elevatum diutinum a rare and poorly understood cutaneous vasculitis: A single institution experience. J Cutan Pathol 2018; 46:97-101. [DOI: 10.1111/cup.13378] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 10/12/2018] [Accepted: 10/16/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Luis A. Sardiña
- Robert J. Tomsich Pathology and Laboratory Medicine Institute; Cleveland Clinic; Cleveland Ohio
| | - George Jour
- Department of Pathology and Dermatology; New Yok Langone Medical Center; New York New York
| | - Melissa P. Piliang
- Robert J. Tomsich Pathology and Laboratory Medicine Institute; Cleveland Clinic; Cleveland Ohio
- Department of Dermatology; Cleveland Clinic; Cleveland Ohio
| | - Wilma F. Bergfeld
- Robert J. Tomsich Pathology and Laboratory Medicine Institute; Cleveland Clinic; Cleveland Ohio
- Department of Dermatology; Cleveland Clinic; Cleveland Ohio
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Affiliation(s)
- Jonathan Kentley
- Department of Dermatology, Whipps Cross University Hospital, Barts Health, London, United Kingdom
| | - Claire Marshall
- Department of Dermatology, York Hospital, York, United Kingdom
| | - Anthony Bewley
- Department of Dermatology, Whipps Cross University Hospital, Barts Health, London, United Kingdom
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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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Maruthappu T, Tharakaram S, Calonje E, Shirlaw PJ, Setterfield J. Erythema elevatum diutinum with oral ulceration. Br J Dermatol 2012; 167:222-4. [PMID: 22284024 DOI: 10.1111/j.1365-2133.2012.10851.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Van Loon K, Gill RM, McMahon P, Chigurupati R, Siddiqi I, Fox L, Damon L, McCalmont TH, Jordan R, Wolf J. 20q- clonality in a case of oral sweet syndrome and myelodysplasia. Am J Clin Pathol 2012; 137:310-5. [PMID: 22261459 DOI: 10.1309/ajcp9i7nrwyltjhv] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
We report the case of a patient with myelodysplasia who had Sweet syndrome of the oral cavity. An atypical myeloid immunophenotype was present in the gingival biopsy specimen and in a concurrent bone marrow specimen. Fluorescence in situ hybridization performed on the gingival biopsy specimen demonstrated the same del(20q) cytogenetic abnormality present in the bone marrow, confirming the presence of a clonally related myeloid proliferation in both tissues. This is the first reported case of Sweet syndrome and myelodysplasia in which the chromosomal abnormality was identified in the neutrophilic infiltrate, confirming the neutrophilic infiltrate to be clonally related to the underlying myeloid neoplasm.
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Cohen PR. Sweet's syndrome--a comprehensive review of an acute febrile neutrophilic dermatosis. Orphanet J Rare Dis 2007; 2:34. [PMID: 17655751 PMCID: PMC1963326 DOI: 10.1186/1750-1172-2-34] [Citation(s) in RCA: 490] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2007] [Accepted: 07/26/2007] [Indexed: 01/19/2023] Open
Abstract
Sweet's syndrome (the eponym for acute febrile neutrophilic dermatosis) is characterized by a constellation of clinical symptoms, physical features, and pathologic findings which include fever, neutrophilia, tender erythematous skin lesions (papules, nodules, and plaques), and a diffuse infiltrate consisting predominantly of mature neutrophils that are typically located in the upper dermis. Several hundreds cases of Sweet's syndrome have been published. Sweet's syndrome presents in three clinical settings: classical (or idiopathic), malignancy-associated, and drug-induced. Classical Sweet's syndrome (CSS) usually presents in women between the age of 30 to 50 years, it is often preceded by an upper respiratory tract infection and may be associated with inflammatory bowel disease and pregnancy. Approximately one-third of patients with CSS experience recurrence of the dermatosis. The malignancy-associated Sweet's syndrome (MASS) can occur as a paraneoplastic syndrome in patients with an established cancer or individuals whose Sweet's syndrome-related hematologic dyscrasia or solid tumor was previously undiscovered; MASS is most commonly related to acute myelogenous leukemia. The dermatosis can precede, follow, or appear concurrent with the diagnosis of the patient's cancer. Hence, MASS can be the cutaneous harbinger of either an undiagnosed visceral malignancy in a previously cancer-free individual or an unsuspected cancer recurrence in an oncology patient. Drug-induced Sweet's syndrome (DISS) most commonly occurs in patients who have been treated with granulocyte-colony stimulating factor, however, other medications may also be associated with DISS. The pathogenesis of Sweet's syndrome may be multifactorial and still remains to be definitively established. Clinical and laboratory evidence suggests that cytokines have an etiologic role. Systemic corticosteroids are the therapeutic gold standard for Sweet's syndrome. After initiation of treatment with systemic corticosteroids, there is a prompt response consisting of dramatic improvement of both the dermatosis-related symptoms and skin lesions. Topical application of high potency corticosteroids or intralesional corticosteroids may be efficacious for treating localized lesions. Other first-line oral systemic agents are potassium iodide and colchicine. Second-line oral systemic agents include indomethacin, clofazimine, cyclosporine, and dapsone. The symptoms and lesions of Sweet's syndrome may resolved spontaneously, without any therapeutic intervention; however, recurrence may follow either spontaneous remission or therapy-induced clinical resolution.
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Affiliation(s)
- Philip R Cohen
- University of Houston Health Center, Houston, Texas, USA.
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Ratzinger G, Burgdorf W, Zelger BG, Zelger B. Acute febrile neutrophilic dermatosis: a histopathologic study of 31 cases with review of literature. Am J Dermatopathol 2007; 29:125-33. [PMID: 17414432 DOI: 10.1097/01.dad.0000249887.59810.76] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Sweet syndrome is a neutrophilic dermatosis defined by diagnostic criteria that include the lack of evidence for leukocytoclastic vasculitis. Because of the clinicopathological similarities on the one hand and the strict exclusion on the other hand, we were interested in a systematic evaluation of the relationship between these two diseases. We investigated the clinical and histopathological characteristics of 31 patients with Sweet syndrome, comparing our cases with 32 cases of leukocytoclastic vasculitis (including seven cases of urticarial vasculitis) and tried to place them in the background of published cases. There is a close relationship between Sweet syndrome and leukocytoclastic vasculitis in terms of clinical appearance, histopathological pattern, triggers, disease course, and response to treatment. The majority of the cases (23/31; 74%) showed histologic evidence of vasculitis, including nuclear dust, extravasation of erythrocytes, fibrin in and around vessel walls, and degeneration of collagen. Although one original criterion for Sweet syndrome is the absence of vasculitis, we propose that vasculitic changes should not exclude the diagnosis of Sweet syndrome. In contrast, Sweet syndrome can demonstrate vasculitis and may, similarly to urticarial vasculitis, be regarded a variant of leukocytoclastic vasculitis. Clinicopathologic characteristics with acute onset of juicy papules, plaques mostly on the face, shoulder, and trunk, and prominent edema probably reflect modifications of the pathogenetic process based on location and disease acuity.
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Affiliation(s)
- Gudrun Ratzinger
- Department of Dermatology and Venereology, Ludwig Maximilian University, Munich, Germany
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Affiliation(s)
- Philip R Cohen
- Dermatologic Surgery Center of Houston, Department of Dermatology, University of Texas-Houston Medical School, Houston, TX, USA.
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Abstract
Sweet's syndrome, also referred to as acute febrile neutrophilic dermatosis, is characterized by a constellation of symptoms and findings: fever, neutrophilia, erythematous and tender skin lesions that typically show an upper dermal infiltrate of mature neutrophils, and prompt improvement of both symptoms and lesions after the initiation of treatment with systemic corticosteroids. Hundreds of patients with this dermatosis have been reported. The manifestations of Sweet's syndrome in these individuals have not only confirmed those originally described by Dr Robert Douglas Sweet in 1964, but have also introduced new features that have expanded the clinical and pathologic concepts of this condition. The history, clinical characteristics, laboratory findings, associated diseases, pathology, and treatment options of Sweet's syndrome are reviewed. The evolving and new concepts of this dermatosis that are discussed include: (i) Sweet's syndrome occurring in the clinical setting of a disease-related malignancy, or medication, or both; (ii) detection of additional sites of extracutaneous Sweet's syndrome manifestations; (iii) discovery of additional Sweet's syndrome-associated diseases; (iv) variability of the composition and/or location of the cutaneous inflammatory infiltrate in Sweet's syndrome lesions; and (v) additional efficacious treatments for Sweet's syndrome.
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Affiliation(s)
- Philip R Cohen
- University of Houston Health Center, Department of Dermatology, The University of Texas-Houston Medical School, Houston, Texas, USA.
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Femiano F, Gombos F, Scully C. Sweet's syndrome: recurrent oral ulceration, pyrexia, thrombophlebitis, and cutaneous lesions. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2003; 95:324-7. [PMID: 12627104 DOI: 10.1067/moe.2003.4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We report a case of Sweet's syndrome with recurrent oral ulceration, pyrexia, skin lesions, and migratory thrombophlebitis, with no detectable systemic cause, during a 2-year follow-up. Biopsy examination both of oral lesions and the skin eruption showed a characteristic dense, perivascular, neutrophilic infiltrate in the lamina propria. Laboratory investigations confirmed an inflammatory syndrome with an increased erythrocyte sedimentation rate, but no underlying cause was found. Sweet's syndrome is a rare immunologically mediated condition that belongs to the group of neutrophilic dermatoses that must be differentiated particularly from Behcet's disease. It is characterized by red-brown plaques and nodules that are frequently painful and occur primarily on the head, neck, and upper extremities. Often the patients also have neutrophilia and fever and may have oral ulceration. In approximately 10% of patients with Sweet's syndrome, there is an associated malignancy--most commonly acute myelogenous leukemia--but some cases, as here, are unassociated with detectable malignant or other disease, although the syndrome may precede the onset of definable systemic disease.
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Bordel MT, Bassas J, Morales AM, Tejerina JA, Aragoneses MH, Miranda A. Eritema elevatum diutinum. ACTAS DERMO-SIFILIOGRAFICAS 2003. [DOI: 10.1016/s0001-7310(03)76694-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Eritema elevatum et diutinum con afectación palmar y asociación con p-ANCA. ACTAS DERMO-SIFILIOGRAFICAS 2002. [DOI: 10.1016/s0001-7310(02)76622-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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