1
|
Vignon-Pennamen MD, Battistella M. From Histiocytoid Sweet Syndrome to Myelodysplasia Cutis: History and Perspectives. Dermatol Clin 2024; 42:209-217. [PMID: 38423682 DOI: 10.1016/j.det.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
In 2005, a new histologic variant of Sweet syndrome (SS) has been described and termed histiocytoid SS (HSS). Clinically, patients had a typical SS, but on skin biopsy, the infiltrates were composed of immature nonblast myeloid cells. Nearly 50% of patients with HSS have myelodysplastic syndrome (MDS). HSS may be the first manifestation leading to the diagnosis of MDS. In 2015, a new category of myeloid dermatosis has been proposed, called myelodysplasia cutis, describing the specific skin infiltration by myelodysplastic cells in patients with MDS.
Collapse
Affiliation(s)
| | - Maxime Battistella
- Pathology Department, APHP Nord, Hopital Saint-Louis, Université Paris Cité, Paris, France; INSERM U976 "Human Immunology, Pathophysiology, and Immunotherapy", Paris, France.
| |
Collapse
|
2
|
Lu SY, Yang HF, Zeng QL, Chen P, Chen L, Gao J, Gu XK, Lan H, Luo M. Atypical Sweet syndrome: skin sinus tracts in an acutely febrile patient after lymphoma treatment: a case report. Front Immunol 2023; 14:1193808. [PMID: 37342351 PMCID: PMC10277476 DOI: 10.3389/fimmu.2023.1193808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 05/18/2023] [Indexed: 06/22/2023] Open
Abstract
Sweet syndrome (SS) is an uncommon inflammatory disease that involves painful skin, edematous, red papules, plaques, or nodules often accompanied by fever and leukocytosis. SS has three subtypes, including classical, malignant-tumor associated, and drug-induced SS (DISS). Patients with DISS have clear histories of recent drug exposure. The incidence of SS is high in hematological malignancy but rare in lymphomas. Glucocorticoid treatment is the recommended treatment for all subtypes of SS. This case study describes a male patient who had a history of sALCL(Systemic anaplastic large cell lymphoma) and was treated with multiple cycles of monoclonal-antibody (mAb) therapy. They also received the G-CSF injection at the site where skin lesions later developed. They met the diagnosis criteria for DISS, which was considered to be caused by the G-CSF injection. In addition, BV(Brentuximab vedotin) administration might predispose them to DISS. This case illustrates the first reported SS during the lymphoma treatment, with rare clinical presentations of local crater-like suppurative skin lesions. This case expands the available literature on SS and hematologic neoplasms and reminds clinicians to promptly recognize and diagnose SS to minimize patient morbidity and long-term sequelae.
Collapse
Affiliation(s)
- Shi-Ying Lu
- Department of Hematology, The Affiliated TCM Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hui-Fang Yang
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Qing-Li Zeng
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Peng Chen
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Li Chen
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Jing Gao
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Xue-Kui Gu
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Hai Lan
- Department of HematologyShunde Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Man Luo
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| |
Collapse
|
3
|
Agrawal A, Arif SH, Kumarasan K, Janjua D. Sweet's Syndrome: An Update. Curr Pediatr Rev 2022; 18:265-273. [PMID: 35209834 DOI: 10.2174/1573396318666220223100208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/20/2021] [Accepted: 12/29/2021] [Indexed: 11/22/2022]
Abstract
Sweet's syndrome is a serious dermatological disorder characterized by a rapid onset of tender plaques or nodules, fever, joint pain, headache, and oral and genital lesions. According to the clinical features and underlying causes, Sweet's syndrome is divided into three categories, i.e., classical (or idiopathic), malignancy-associated Sweet's syndrome, and drug-induced Sweet's syndrome. It is multifactorial in etiology, and the exact cause is still undetermined. The diagnosis can be confirmed by the routine histopathologic evaluation of skin biopsy from the lesions. The first-line treatment options are topical and systemic steroids. Multiple databases, like Medline/PubMed, Scopus, and Google, were used to identify resources for this literature review. The relevant information was collected from various case reports, case series, reviews, meta-analyses, and large clinical trials reporting clinical description, etiology, diagnosis, and management of Sweet's syndrome. This narrative review aimed to discuss recent understandings related to Sweet's syndrome, both in terms of clinical presentation and management approach.
Collapse
Affiliation(s)
- Amit Agrawal
- Department of Pediatrics, Gandhi Medical College, Bhopal, MP, India
| | | | | | | |
Collapse
|
4
|
Nelson CA, Stephen S, Ashchyan HJ, James WD, Micheletti RG, Rosenbach M. Neutrophilic dermatoses: Pathogenesis, Sweet syndrome, neutrophilic eccrine hidradenitis, and Behçet disease. J Am Acad Dermatol 2018; 79:987-1006. [PMID: 29653210 DOI: 10.1016/j.jaad.2017.11.064] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/06/2017] [Accepted: 11/08/2017] [Indexed: 12/24/2022]
Abstract
Neutrophilic dermatoses are a heterogeneous group of inflammatory skin disorders that present with unique clinical features but are unified by the presence of a sterile, predominantly neutrophilic infiltrate on histopathology. The morphology of cutaneous lesions associated with these disorders is heterogeneous, which renders diagnosis challenging. Moreover, a thorough evaluation is required to exclude diseases that mimic these disorders and to diagnose potential associated infectious, inflammatory, and neoplastic processes. While some neutrophilic dermatoses may resolve spontaneously, most require treatment to achieve remission. Delays in diagnosis and treatment can lead to significant patient morbidity and even mortality. Therapeutic modalities range from systemic corticosteroids to novel biologic agents, and the treatment literature is rapidly expanding. The first article in this continuing medical education series explores the pathogenesis of neutrophilic dermatoses and reviews the epidemiology, clinical and histopathologic features, diagnosis, and management of Sweet syndrome, neutrophilic eccrine hidradenitis, and Behçet disease.
Collapse
Affiliation(s)
- Caroline A Nelson
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sasha Stephen
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hovik J Ashchyan
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - William D James
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert G Micheletti
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Misha Rosenbach
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| |
Collapse
|
5
|
Kazlouskaya V, Junkins-Hopkins JM. Lymphocytes in Sweet syndrome: A potential diagnostic pitfall. J Cutan Pathol 2018; 45:217-222. [PMID: 29265393 DOI: 10.1111/cup.13096] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/12/2017] [Accepted: 12/14/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with Sweet syndrome (SS) have acute onset of cutaneous lesions with characteristic histopathology (dense and diffuse neutrophilic infiltrate, dermal edema, leukocytoclasis and no vasculitis) accompanied by systemic symptoms. Sometimes, only skin lesions with classic histopathologic features are seen. Although SS is considered to be a "neutrophilic dermatosis," lymphocytes are also seen on histological examination. METHODS We evaluated the cellular infiltrate in 9 biopsies from SS lesions with routine staining and immunohistochemistry. RESULTS Lymphocytes were present in all biopsies in variable amounts, often exceeding the number of intact neutrophils. Prominent fragmentation of neutrophils rendered some biopsies "lymphocyte-rich" on routine histologic evaluation. Myeloperoxidase was helpful in highlighting the inconspicuous neutrophilic fragments in these cases. Lymphocytes were highlighted with immunohistochemistry, and had a CD3+, CD4+, CD20(-) immunophenotype, with rare CD8+ lymphocytes. CONCLUSION Awareness of the lymphocytic component of SS is important to avoid diagnostic errors, especially in subcutaneous lesions of SS, in which the lymphocytic infiltrate predominates in the upper parts of the dermis, while the typical neutrophilic infiltrate may be seen only in the deeper dermis and subcutis. The lymphocytic component may potentially help to differentiate lesions of SS from neutrophilic urticarial dermatosis, which has not been reported to contain a significant lymphocytic population.
Collapse
|
6
|
Atypical Histiocyte-Rich Sweet's Syndrome. Case Rep Dermatol Med 2017; 2017:8150719. [PMID: 29181206 PMCID: PMC5664242 DOI: 10.1155/2017/8150719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 09/20/2017] [Indexed: 11/17/2022] Open
Abstract
Sweet's Syndrome is a rare neutrophilic dermatosis thought to be a result of immune dysregulation occurring in the setting of drug exposure, recent infection, pregnancy, and underlying malignancy or idiopathic with specific and widely accepted diagnostic criteria established in the literature. Other organ systems can be involved with varying degrees of severity. An unusual case of Sweet's Syndrome associated with myopericarditis, acral involvement, and atypical histological findings with predominance of histiocytes is described here.
Collapse
|
7
|
Ghoufi L, Ortonne N, Ingen-Housz-Oro S, Barhoumi W, Begon E, Haioun C, Pautas C, Beckerich F, Robin C, Wolkenstein P, Cordonnier C, Chosidow O, Toma A. Histiocytoid Sweet Syndrome Is More Frequently Associated With Myelodysplastic Syndromes Than the Classical Neutrophilic Variant: A Comparative Series of 62 Patients. Medicine (Baltimore) 2016; 95:e3033. [PMID: 27082547 PMCID: PMC4839791 DOI: 10.1097/md.0000000000003033] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Histiocytoid Sweet syndrome (H-SS) is a histological variant of Sweet syndrome (SS) differing from classical neutrophilic SS (N-SS) by a dermal infiltrate mainly composed of lymphocytes and histiocytoid myeloperoxidase-positive cells. We aimed to report a large series of H-SS and compare the frequency and type of hematological malignancies associated to H-SS and N-SS. We included 62 patients with a coding histopathologic diagnosis of SS prospectively registered between 2005 and 2014 in the database of our Department of Pathology. Overall, 22 (35.5%) and 40 (64.5%) patients had a histological diagnosis of H-SS and N-SS, respectively. Median age, sex ratio, and cutaneous lesions were similar in the 2 groups. The frequency of extra-cutaneous manifestations was similar (50% vs 37.5%, P = 0.42). Recurrent forms were significantly more frequent in H-SS than in N-SS patients (21% vs 2.5%, P = 0.01). A hematological malignancy was diagnosed in 22 patients, 12 (55.5%) with H-SS and 10 (25%) with N-SS (P = 0.019). Hematological malignancy was of myeloid origin in 8/22 (36.3%) H-SS and 5/40 (12.5%) N-SS patients (P = 0.02), and of lymphoid origin without myeloid component in 4/22 (18.1%) H-SS and 4/40 (10%) N-SS patients (P = 0.35), respectively. One N-SS patient had a hematological malignancy of mixed (myeloid and lymphoid) phenotype. A myelodysplastic syndrome (MDS) was diagnosed in 7/22 (31.8%) H-SS and 1/40 (2.5%) N-SS patients (P < 0.001). Hematological disease was diagnosed before (in 8 H-SS and 3 N-SS patients) or at the time of the occurrence of the cutaneous lesions (in 1 H-SS and 7 N-SS patients). However, in 3 H-SS patients, all with MDS, cutaneous lesions preceded the hematological disease by ≤6 months. In conclusion, H-SS was associated with MDS in one third of patients but also with lymphoid malignancies, and cutaneous lesions could precede the hematological diagnosis in patients with MDS. A complete hematological assessment is mandatory at diagnosis, and monitoring blood cell counts should be recommended for at least 6 months after the diagnosis of H-SS.
Collapse
Affiliation(s)
- Lisa Ghoufi
- From the Department of Dermatology, Assistance-Publique-Hopitaux-de-Paris (AP-HP), Groupe Hospitalier Henri Mondor-Albert Chenevier, Créteil, France (LG, SI-HO, PW, OC); Université Paris-Est Créteil (UPEC) (NO, CH, PW, CC, OC); UMR-S 955, Faculté de Médecine, Hopital Henri Mondor, Créteil, France (NO); Department of Pathology, AP-HP, Groupe Hospitalier Henri Mondor-Albert Chenevier, Créteil, France (NO); Department of Hematology, AP-HP, Groupe Hospitalier Henri Mondor-Albert Chenevier, Créteil, France (WB, CP, FB, CR, CC, AT); Department of Dermatology, Centre Hospitalier René Dubos, Pontoise, France (EB); and Lymphoid Malignancies Unit, AP-HP, Groupe Hospitalier Henri Mondor-Albert Chenevier, Créteil, France (CH)
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Kim J, Chan JJ. Cyclophosphamide in dermatology. Australas J Dermatol 2016; 58:5-17. [PMID: 26806212 DOI: 10.1111/ajd.12406] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 09/02/2015] [Indexed: 01/19/2023]
Abstract
Cyclophosphamide is a chemotherapeutic agent which was first discovered in experimental tumours in rats, and it has since been widely used to treat malignancies and severe manifestations of various auto-immune diseases. High-dose chemotherapy and continuous daily oral regimens are associated with significant toxicity profiles, but i.v. pulsed regimens have lowered the rates of adverse effects in rheumatological studies. Cyclophosphamide has been shown to be useful in the treatment of severe autoimmune conditions due to its powerful immunosuppressive ability; however, it remains a relatively underused modality in dermatology. This article reviews the current literature on cyclophosphamide and its clinical applications in dermatology.
Collapse
Affiliation(s)
- Janet Kim
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Jonathan J Chan
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| |
Collapse
|
9
|
Kakaletsis N, Kaiafa G, Savopoulos C, Iliadis F, Perifanis V, Tzalokostas V, Grekou A, Giannouli A, Hatzitolios AI. Initially lymphocytic Sweet's syndrome in male patients with myelodysplasia: a distinguished clinicopathological entity? Case report and systematic review of the literature. Acta Haematol 2014; 132:220-5. [PMID: 24714374 DOI: 10.1159/000357933] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 12/12/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Sweet's syndrome (SS) is an acute febrile neutrophilic dermatosis. It can occur as an idiopathic, drug-induced or malignancy-associated entity. SS is also seen in patients with myelodysplastic syndrome (MDS) where it may present atypically, both clinically and histologically. In a few rare cases of MDS, lymphocytic infiltrates are the presenting feature of SS. METHODS MEDLINE and Scopus were the data sources for our review. RESULTS A clinicopathological subsetemerged of 12 male SS patients with MDS and a mean age of 67.3 years in which the initial SS lesions were lymphocytic infiltrates. However, from 0.5 to 8 years later, sequential biopsies revealed neutrophilic dermal infiltration typical of SS. CONCLUSION Initially lymphocytic infiltrates in this subset could be attributed either to an early timing of the biopsy concerning the age of the lesion or to the dysgranulopoiesis syndrome. A possible relationship between the dysfunction of the receptor of the granulocyte-macrophage colony stimulating factor, the gene of which is located on the pseudoautosomal X-Y region, may exist in MDS patients with initially lymphocytic SS. This could explain the male gender of this subset and might establish initially lymphocytic SS as a distinguished clinicopathological entity for predicting the occurrence and even the prognosis of MDS.
Collapse
MESH Headings
- Aged
- Anemia, Refractory, with Excess of Blasts/complications
- Anemia, Refractory, with Excess of Blasts/pathology
- Biopsy
- Chromosomes, Human, X/genetics
- Chromosomes, Human, Y/genetics
- Disease Progression
- Humans
- Lymphocytes/pathology
- Male
- Middle Aged
- Models, Immunological
- Myelodysplastic Syndromes/complications
- Myelodysplastic Syndromes/pathology
- Neutrophil Infiltration
- Receptors, Granulocyte-Macrophage Colony-Stimulating Factor/genetics
- Receptors, Granulocyte-Macrophage Colony-Stimulating Factor/physiology
- Sex Factors
- Skin/pathology
- Sweet Syndrome/etiology
- Sweet Syndrome/genetics
- Sweet Syndrome/immunology
- Sweet Syndrome/pathology
Collapse
|
10
|
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
|
11
|
Abstract
Neutrophilic dermatoses, including Sweet's syndrome, pyoderma gangrenosum, and rheumatoid neutrophilic dermatitis, are inflammatory conditions of the skin often associated with underlying systemic disease. These are characterized by the accumulation of neutrophils in the skin. The associated conditions, potential for systemic neutrophilic infiltration, and therapeutic management of these disorders can be similar. Sweet's syndrome can often be effectively treated with a brief course of systemic corticosteroids. Pyoderma gangrenosum, however, can be recurrent, and early initiation of a steroid-sparing agent is prudent. Second-line treatment for both of these conditions includes medications affecting neutrophil function, in addition to immunosuppressant medications.
Collapse
Affiliation(s)
- Courtney R Schadt
- Division of Dermatology, University of Louisville, 310 East Broadway, Louisville, KY 40202, USA.
| | | |
Collapse
|
12
|
Meinhardt C, Büning J, Fellermann K, Lehnert H, Schmidt KJ. Cyclophosphamide therapy in Sweet's syndrome complicating refractory Crohn's disease − Efficacy and mechanism of action. J Crohns Colitis 2011; 5:633-7. [PMID: 22115387 DOI: 10.1016/j.crohns.2011.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 07/24/2011] [Accepted: 07/25/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND Sweet's syndrome is a rare extraintestinal manifestation of Crohn's disease that is usually treated by corticosteroids. Cyclophosphamide therapy has been shown to be effective in steroid-refractory Crohn's disease with extraintestinal manifestations. The mechanism of action remains obscure. Here, we report about a case of steroid-refractory Sweet's syndrome accompanying Crohn's colitis treated by cyclophosphamide. METHODS At baseline and two weeks after initiating cyclophosphamide pulse therapy, clinical symptoms were evaluated and apoptosis in mononuclear cells of the colon mucosa was quantified via immunofluorescence TUNEL-labeling. Ongoing clinical follow-up lasts for more than three years. RESULTS Cyclophosphamide pulse therapy resulted in complete resolution of luminal activity and extraintestinal manifestations. TUNEL-marked CD4(+), CD8(+) and CD68(+) cells in intestinal biopsies showed a 338% increase as compared to baseline. CONCLUSIONS Cyclophosphamide therapy was highly effective in steroid-refractory Crohn's colitis accompanied by Sweet's syndrome for induction of remission. Furthermore, apoptosis of mononuclear cells in the colon mucosa, including CD68(+) macrophages as well as CD4(+) and CD8(+) cells, appears to be a component of the anti-inflammatory effect of cyclophosphamide in Crohn's disease.
Collapse
Affiliation(s)
- Christian Meinhardt
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | | | | | | | | |
Collapse
|
13
|
Farah C, Bulai Livideanu C, Jegu J, Paul C, Viraben R, Lamant L, Delavigne K, Adoue D, Laurent G, Beyne Rauzy O. Prevalence and prognostic value of cutaneous manifestations in patients with myelodysplastic syndrome. J Eur Acad Dermatol Venereol 2011; 24:1171-5. [PMID: 20202054 DOI: 10.1111/j.1468-3083.2010.03614.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Skin manifestations associated with myelodysplastic syndrome (MDS) may reveal bone marrow transformation into acute myeloid leukaemia. OBJECTIVE The objective of this study was to assess the prevalence of skin manifestations associated with MDS. In addition, we evaluated the risk of acute myeloid leukaemia transformation associated with skin manifestations. METHODS We studied a cohort of 157 patients with primary MDS followed up prospectively for a median of 44 months. Skin lesions were prospectively assessed as part of medical examination every 6 months by a board certified dermatologist. Survival analyses were performed to assess the association between the presence of skin lesions and the risk of acute myeloid leukaemia. RESULTS Fifteen patients (9.55%) experienced skin lesions previously reported as associated with MDS. These were neutrophilic dermatosis (7, 4.46%), specific lesions (5, 3.18%), cutaneous vasculitis (2, 1.27%) and Behçet disease (1, 0.63%). Survival analysis showed that the risk of transformation into acute myeloid leukaemia was slightly but not significantly increased in patients with skin lesions as compared with patients without skin lesions with a relative risk of 2.08 (95% CI 0.92-4.67). CONCLUSION The prevalence of skin lesions, mostly neutrophilic dermatosis and specific lesions, is relatively high in patients with MDS. There is a trend for a higher risk of transformation into acute myeloid leukaemia in patients with skin lesions.
Collapse
Affiliation(s)
- C Farah
- Department of Dermatology, Toulouse University Hospital, , Toulouse Cedex 9, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Torrelo A, Patel S, Colmenero I, Gurbindo D, Lendínez F, Hernández A, López-Robledillo JC, Dadban A, Requena L, Paller AS. Chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature (CANDLE) syndrome. J Am Acad Dermatol 2010; 62:489-95. [PMID: 20159315 DOI: 10.1016/j.jaad.2009.04.046] [Citation(s) in RCA: 164] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Revised: 04/20/2009] [Accepted: 04/20/2009] [Indexed: 12/01/2022]
Abstract
Several syndromes manifest as recurrent daily fevers, skin lesions, and multisystem inflammation. We describe 4 patients with early-onset recurrent fevers, annular violaceous plaques, persistent violaceous eyelid swelling, low weight and height, lipodystrophy, hepatomegaly, and a range of visceral inflammatory manifestations. Laboratory abnormalities included chronic anemia, elevated acute-phase reactants, and raised liver enzymes. Histopathologic examination of lesional skin showed atypical mononuclear infiltrates of myeloid lineage and mature neutrophils. Our patients have a distinctive early-onset, chronic inflammatory condition with atypical or immature myeloid infiltrates in the skin. We propose the acronym CANDLE (chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature) syndrome for this newly described disorder, which is probably genetic in origin.
Collapse
Affiliation(s)
- Antonio Torrelo
- Department of Dermatology, Hospital del Niño Jesús, Menéndez Pelayo 65, 28009-Madrid, Spain.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Guitart J, Querfeld C. Cutaneous CD30 lymphoproliferative disorders and similar conditions: a clinical and pathologic prospective on a complex issue. Semin Diagn Pathol 2010; 26:131-40. [PMID: 20043512 DOI: 10.1053/j.semdp.2009.09.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We elaborate on the diagnosis of CD30 positive cutaneous lymphoproliferative conditions including the various clinical and pathological presentations, our understanding of its pathomechanisms and prognostic implications. The most common reactive conditions that can simulate CD30 lymphoproliferative conditions, including arthropod bite reactions, various viral infections, pityriasis lichenoides and lymphocytic papules in myelodysplastic syndrome, are discussed in detail.
Collapse
Affiliation(s)
- Joan Guitart
- Cutaneous Lymphoma Clinic and Dermatopathology Laboratory, Northwestern University, Feinberg Medical School, Chicago, Illinois 60611, USA.
| | | |
Collapse
|
16
|
Stem cell transplant for myelodysplastic syndrome-associated histiocytoid sweet's syndrome in a patient with arthritis and myalgias. ACTA ACUST UNITED AC 2008; 59:1832-4. [DOI: 10.1002/art.24061] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
17
|
Boeckler P, Noacco G, Maradeix S, Heid E, Lipsker D, Cribier B. [Lymphocytic infiltrate of the dermis preceding typical Sweet's syndrome]. Ann Dermatol Venereol 2007; 134:559-63. [PMID: 17657184 DOI: 10.1016/s0151-9638(07)89269-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The histologic criteria for Sweet's syndrome consist in prominent oedema of the dermis and a diffuse infiltrate of numerous neutrophils with leukocytoclasis without vasculitis in the superficial and the deep dermis. Several comorbidities have been observed in patients with Sweet's syndrome, particularly hemo-proliferative diseases. PATIENTS We report the cases of two men aged 60 and 75 years with Sweet's syndrome associated in one case with myelodysplasia and in the other with chronic lymphocytic leukemia. These two patients had typical edematous plaques highly evocative of Sweet's syndrome. However, histological examination revealed superficial and deep perivascular lymphocytic infiltrate in the dermis on 5 occasions before the typical neutrophilic dermatosis of Sweet's could be diagnosed after respectively 2 and 4 years of progression. DISCUSSION Histological findings in Sweet's syndrome are characteristic and constitute a major diagnostic factor. However, these two cases show that a lymphocytic infiltrate can occur months or even years before the appearance of typical neutrophilic infiltrate in patients with Sweet's syndrome.
Collapse
MESH Headings
- Adrenal Cortex Hormones/therapeutic use
- Aged
- Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
- Dapsone/therapeutic use
- Dermis/pathology
- Drug Therapy, Combination
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Lymphocytes/pathology
- Male
- Middle Aged
- Neural Tube Defects/complications
- Neural Tube Defects/diagnosis
- Neural Tube Defects/drug therapy
- Neural Tube Defects/pathology
- Sweet Syndrome/complications
- Sweet Syndrome/diagnosis
- Sweet Syndrome/drug therapy
- Sweet Syndrome/pathology
- Treatment Outcome
Collapse
Affiliation(s)
- P Boeckler
- Clinique Dermatologique, Hôpitaux Universitaires de Strasbourg.
| | | | | | | | | | | |
Collapse
|
18
|
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.
Collapse
Affiliation(s)
- Philip R Cohen
- University of Houston Health Center, Houston, Texas, USA.
| |
Collapse
|
19
|
Raj K, Ho A, Creamer JD, du Vivier AWP, Salisbury JR, Mufti GJ. Complete response of deep neutrophilic dermatosis associated with myelodysplastic syndrome to 5-azacytidine. Br J Dermatol 2007; 156:1039-41. [PMID: 17408390 DOI: 10.1111/j.1365-2133.2007.07831.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cutaneous manifestations of myelodysplastic syndromes (MDS) may predict disease progression and a poorer prognosis. We describe a patient in whom a deep neutrophilic dermatosis preceded evolution of disease from refractory anaemia to RAEB (refractory anaemia with excess blasts) and resolved completely on treating the disease with 5-azacytidine. The dermatological response was accompanied by complete bone marrow remission and trilineage haematological improvement. We suggest that 5-azacytidine should be considered in the treatment of immune mediated cutaneous manifestations of MDS.
Collapse
Affiliation(s)
- K Raj
- Department of Haematological Medicine, King's College London and King's College Hospital, Denmark Hill, London, UK
| | | | | | | | | | | |
Collapse
|
20
|
Browning CE, Dixon JE, Malone JC, Callen JP. Thalidomide in the treatment of recalcitrant Sweet's syndrome associated with myelodysplasia. J Am Acad Dermatol 2005; 53:S135-8. [PMID: 16021163 DOI: 10.1016/j.jaad.2004.12.041] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Sweet's syndrome is a neutrophilic dermatosis characterized by tender, erythematous, pseudovesicular plaques that can be associated with hematologic malignancy. We report a patient with recalcitrant Sweet's syndrome that preceded the development of myelodysplastic syndrome by 30 months. The delay between the onset of Sweet's syndrome and the subsequent diagnosis of myelodysplasia highlights the need for thorough and repeated evaluation for underlying malignancy in patients with such a course. Although corticosteroids are the initial treatment of choice, this patient's eruption was only partially responsive to high-dose prednisone and was refractory to metronidazole, dapsone, and methotrexate. Treatment with thalidomide resulted in complete resolution of the cutaneous lesions within one month of therapy.
Collapse
Affiliation(s)
- Catherine E Browning
- Division of Dermatology, Department of Medicine, University of Louisville, Louisville, Kentucky, USA
| | | | | | | |
Collapse
|
21
|
Belhadjali H, Marguery MC, Lamant L, Giordano-Labadie F, Bazex J. Photosensitivity in Sweet's syndrome: two cases that were photoinduced and photoaggravated. Br J Dermatol 2003; 149:675-7. [PMID: 14511020 DOI: 10.1046/j.1365-2133.2003.05487.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|