Sweet Syndrome and Neutrophilic Dermatosis of the Dorsal Hands

Sweet syndrome is a rare cutaneous condition with a broad clinical differential diagnosis. It can be classified into 3 subtypes: classic, malignancy-associated, and drug-induced. There are numerous associated disorders and provoking medications. Uncommonly, it can present as a multiorgan disease and cause significant morbidity. Systemic corticosteroids are the gold standard of treatment and yield rapid improvements in both lesions and symptoms. Nonsteroidal therapies may be effective alternatives, although high-quality comparative data are lacking. Some treatments for Sweet syndrome have paradoxically been implicated in the induction of disease.

Multiple painful plaques and the Sweet's syndrome

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.

Sweet syndrome with osseous and splenic involvement: A case report

Sweet syndrome is an uncommon inflammatory skin condition. Here we present a case of Sweet syndrome in a young woman with rare extracutaneous manifestations, including bone and splenic fluid collections, with marked improvement following treatment with systemic corticosteroids. The patient was subsequently diagnosed with Crohn's disease which can be seen in the setting of Sweet syndrome. Sterile abscesses should be considered in patients with a clinical diagnosis of Sweet syndrome and focal symptomatology.

Sweet syndrome with bitter outcomes in cervical cancer: A case report

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Sweet Syndrome is an acute, non-infectious rash with fever and leukocytosis.

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It is either idiopathic, drug-induced or malignancy-associated (MASS).

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MASS manifests with leukopenia, anemia, and thrombocytopenia.

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MASS workup should include prompt punch biopsy and cancer surveillance screening.

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In cervical cancer, MASS is often an ominous indicator of recurrence or progression.

Background

Sweet Syndrome, or acute febrile neutrophilic dermatosis, is a non-infectious, painful rash accompanied by fever, leukocytosis and skin biopsy showing neutrophilic dermal inflammation. It is either idiopathic, drug-induced or malignancy associated (MASS). MASS is uncommon in cervical cancer, and usually signals diagnosis, progression or recurrence.

Clinical Course

Two months following chemoradiation for stage IIIC2(r) squamous cell carcinoma (SCC) of the cervix, a 55-year-old female developed painful papules and plaques on her left toes. One week later she developed fever and the rash spread to her body. Labs revealed leukopenia and an elevated erythrocyte sedimentation rate. Punch biopsy showed neutrophilic dermal inflammation with papillary dermal edema and was negative for infectious immunohistochemistry. The clinical presentation and histopathological features were consistent with, and met diagnostic criteria for Sweet Syndrome. One month following Sweet Syndrome diagnosis and four months following chemoradiation, positron emission tomography scan revealed recurrence in the pelvic lymph nodes. At this time, she had residual rash on her thighs that responded to oral methylprednisolone. She declined further chemotherapy for recurrent SCC and opted for palliative care.

Conclusion

We present a rare case of MASS in cervical cancer associated with recurrence two months after chemoradiation.

Sweet's syndrome associated with hematological malignancies

BACKGROUND

Sweet's syndrome, or acute febrile neutrophilic dermatosis, is often mistaken for a skin infection given its similar clinical presentation.

OBJECTIVE

To describe the clinical presentations and management of a rare dermatologic condition associated with hematological malignancies.

METHODS

Case series; Chart review of patients at Moffitt Cancer Center between 2017 and 2020.

RESULTS

The subjects are a 79 year-old man (Patient 1) with Myelodysplastic Syndrome (MDS), a 66 year-old woman (Patient 2) with Acute Myeloid Leukemia (AML), a 56 year-old man (Patient 3) with AML, and a 69 year-old man (Patient 4) with MDS. Patient 1 was initially misdiagnosed with neutropenic fever. Patient 2 was incidentally discovered to have erythematous skin lesions prior to initiating chemotherapy. Before starting second line chemotherapy, patient 3 developed pathergy at the site of a PICC line. Patient 4 developed erythema around a newly placed port before initiating chemotherapy. Only patients 1 and 3 received glucocorticoids. Patients 2, 3, and 4 were able to initiate chemotherapy without further complications.

LIMITATIONS

Heterogeneity of subjects in terms of prognostic factors, stage at diagnosis, and treatment strategies.

CONCLUSION

Early recognition and treatment of malignancy-associated Sweet's syndrome is imperative to limit patient morbidity and expeditiously provide anti-cancer treatments.

Panuveitis in Sweet syndrome

Ocular manifestations of Sweet syndrome, or acute febrile neutrophilic dermatosis, are usually limited to the anterior segment. We report the case of a patient with bilateral panuveitis and retinal vasculitis associated with Sweet syndrome. A 45-year-old Asian female with an undiagnosed febrile illness with rash presented with bilateral panuveitis with haemorrhagic occlusive retinal vasculitis. Skin biopsy confirmed Sweet Syndrome. Intraocular inflammation resolved with a combination of topical and systemic corticosteroids as well as intravenous cyclophosphamide, with resulting permanent severe right visual impairment. Although an uncommon condition, Sweet syndrome should be considered in any febrile patient with skin lesions and uveitis.

Ocular involvement in a patient with Sweet syndrome: report of a case and review of the literature

The case presented is a 66-year-old woman who attended the emergency department due to skin lesions on the limbs, facial oedema, and eye redness accompanied by haemorrhagic conjunctivitis. The symptoms resolved after one week of systemic steroid treatment. Skin biopsy confirmed Sweet syndrome. Sweet syndrome is rare disorder and unknown by most ophthalmologists despite its frequent ophthalmological manifestations. Ocular involvement is present in one third of patients, with episcleritis and conjunctivitis being the most repeated. Pathology findings confirm the diagnosis which is also characterised by a rapid response to systemic corticosteroids.

Giant cellulitis-like Sweet syndrome: An underrecognized clinical variant mimicking skin and soft tissue infection

A new clinical variant of Sweet syndrome, called giant cellulitis-like Sweet syndrome, can masquerade as cellulitis because the patients present with an acute onset of large erythematous plaques, fever, and leukocytosis with neutrophil predominance. This case describes a 90-year-old female with a history of invasive ductal carcinoma of the breast who presented with 3 days of erythema of the right chest and right leg. Physical examination was notable for well-demarcated, blanching erythematous rashes involving the right chest and right lower extremity. Laboratory data was notable for neutrophilic leukocytosis. A clinical diagnosis of cellulitis was made initially, and intravenous cefazolin was initiated. The rash had only partially improved with antibiotics. Skin biopsy revealed a dense neutrophilic infiltrate, which was consistent with Sweet syndrome. Based on the widespread plaques, this case was considered a “giant cellulitis-like” variant of Sweet syndrome. Clinicians should have a high index of suspicion for Sweet syndrome when assessing a patient with fever, neutrophilia and erythematous skin plaques atypical of cellulitis because this condition does not respond to antimicrobial therapy and requires systemic glucocorticoid therapy.

[Sweet syndrome in a 5-year-old girl]

Sweet syndrome, also known as acute febrile neutrophilic dermatosis, is an infrequent dermatological disorder in pediatrics. Clinically it is characterized by the development of papular and/or nodular lesions of a reddish-violet coloration with local hypersensitivity. We report the case of a 5-year-old female who consulted 1 month after the appearance of the lesion in the nasal arch. A skin biopsy was performed and it reported diffuse dermatitis with a predominance of neutrophil polymorphonuclear cells, epidermal necrosis and absence of vasculitis. No microorganisms were identified. It was considered compatible with Sweet syndrome. It is important to consider this diagnosis in similar clinical cases and other more frequent diagnoses must be ruled out first.

Sweet's syndrome in a patient with Crohn's disease

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.

Sweet's syndrome: a clinical entity need to discriminate against acute haematogenous periprosthetic joint infection

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.

Sweet's Syndrome Successfully Treated with Granulocyte and Monocyte Adsorption Apheresis

Sweet's syndrome is a neutrophilic dermatosis characterized by an abrupt onset of painful erythematous lesions showing neutrophilic infiltrates in the dermis. Fever and an elevated neutrophil level are generally observed. Sweet's syndrome may be idiopathic, malignancy-associated, or drug-induced (mainly involving granulocyte colony-stimulating factor (G-CSF) administration). Although systemic corticosteroids are usually effective, the symptoms of Sweet's syndrome recur in some refractory cases. Herein, we report a case of a 55-year-old Japanese woman with recurrent symptoms of fever (>39°C) and painful erythematous lesions on her four extremities, trunk, and neck. Laboratory findings revealed leukocytosis and high levels of C-reactive protein (CRP) and G-CSF. She was diagnosed with a recurrence of Sweet's syndrome, and was exclusively treated with granulocyte and monocyte adsorption apheresis (GMA) therapy once a week for 3 consecutive weeks. After the first session of GMA therapy, all symptoms including the erythematous lesions and fever were completely resolved, and serum G-CSF level was reduced. Leukocyte count, neutrophil count, serum amyloid A protein, and CRP levels were restored within normal ranges by 2 weeks. Thus, GMA therapy can successfully treat a patient with recurrent Sweet's syndrome, potentially related to the restoration of elevated serum G-CSF levels.

Characteristics of Sweet Syndrome in patients with acute myeloid leukemia

INTRODUCTION

Sweet syndrome (SS) is associated with hematologic malignancies including acute myeloid leukemia (AML).

PATIENTS AND METHODS

Records of patients with AML treated at our institution were reviewed to identify those with SS. Patient characteristics, laboratory values, and cytogenetic and molecular abnormalities were retrospectively reviewed.

RESULTS

We identified 21 of 2178 (1%) AML patients who demonstrated clinical signs and symptoms, and histological features consistent with SS. Eleven patients (52%) were classified as AML with myelodysplasia-related features and 3 patients had therapy-related AML. Three patients had received treatment with granulocyte colony stimulation factor, 1 patient liposomal all-trans-retinoic acid, and 2 patients received hypomethylating agents before development of SS. Cytogenetic analysis revealed diploid karyotype in 7 patients (33%); -5/del(5q) in 8 patients (38%): 3 patients had -5/del(5q) as the sole abnormality and 5 patients had -5/del(5q) as part of complex cytogenetics; and complex cytogenetics in 5 patients (24%). Gene mutations in FMS-related tyrosine kinase-3 (FLT3) gene were identified in 7 of 18 evaluable patients (39%), including FLT3-internal tandem duplication in 4 patients and FLT3-D835 tyrosine kinase domain mutation in 3 patients.

CONCLUSION

SS occurs in 1% of AML patients; -5/del(5q) karyotype, FLT3 mutations, and AML with myelodysplasia-related features were more frequent among patients with SS.

Sweet's syndrome in human immune deficiency virus-infected patient

Sweet's syndrome is an uncommon dermatosis and can be associated with a wide variety of illnesses including infections and malignancies. Sweet's syndrome as a dermatological manifestation in human immunedeficiency virus (HIV) infection is rarely reported. Furthermore, called acute febrile neutrophilic dermatosis is characterized by fever and skin lesions, which are often erythematous papules and pseudovesicles. Diagnosis is based on clinical features and histology. The gold standard for treatment is systemic steroids although many other medications have been tried with variable success. We here report a case of Sweet's syndrome in an HIV-infected patient.

Localized Sweet's Syndrome in an Irradiated Field

Sweet's syndrome is a reactive dermatosis characterized clinically by fever, leukocytosis, and multiple, erythematous, painful plaques. Histopathologic examination reveals a band-like dense dermal inflammatory infiltrate composed mainly of neutrophils with papillary dermal edema, and no features of vasculitis. We report a case of a 56-year-old female diagnosed with cervical cancer, who underwent surgery and concurrent chemoradiation therapy. Approximately 3 years after completing treatment, she presented with erythematous plaques, principally within the radiation field; the skin biopsy showed features consistent with Sweet's syndrome.