Neutrophilic dermatosis of the dorsal hands related to cocaine abuse

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.

Sweet syndrome associated with secondary nodular syphilis in an immunocompetent patient

Abstract Sweet syndrome is an inflammatory disease characterized by fever, neutrophilia, papules and erythematous plaques, and a skin neutrophilic infiltrate. Syphilis has been reported among the infectious causes of Sweet syndrome. Syphilis can present atypical manifestations; a rare presentation is nodular syphilis, characterized by nodules with granulomas and plasma cells at histopathology. This case report presents a 20-year-old woman patient, with plaques and nodules, and systemic symptoms. The histopathological exam revealed both non-tuberculoid granulomas and a dense infiltration of polymorphonuclear neutrophils in the dermis. These findings, plus laboratory abnormalities, characteristic of both conditions, were conclusive for Sweet syndrome and nodular syphilis association.

Síndrome de Sweet asociado a infección por el Virus de la Inmunodeficiencia Humana / Sweet's syndrome associated to human immunodeficiency virus infection

El síndrome de Sweet es una dermatosis neutrofílica aguda y febril que puede ser desencadenada por diferentes noxas. El diagnóstico es clínico a partir de una dermatosis aguda, con fiebre, leucocitosis y lesiones cutáneas localizadas en cara, cuello y extremidades. La histopatología muestra un denso infiltrado inflamatorio de la dermis a predominio neutrofílico, sin signos de vasculitis. Se presenta un paciente con síndrome de Sweet asociado a infección por el virus de la inmunodeficiencia humana

Sweet's syndrome associated with human immunodeficiency virus infection Sweet's syndrome is a neutrophilic and acute febrile dermatosis that can be triggered by different noxas. Diagnosis should be suspected in a patient with fever, leukocytosis and cutaneous lesions located on the face, the neck and the extremities. Cutaneous biopsy confirms the diagnosis of Sweet syndrome, with typical features of a neutrophilic dermatosis in the absence of vasculitis. Here we present a case of Sweet syndrome associated with human immunodeficiency virus infection

Síndrome de Sweet en una niña preescolar / Sweet syndrome in a 5-year-old girl

El síndrome de Sweet, también conocido como dermatosis neutrofílica febril, es un trastorno dermatológico poco frecuente en pediatría. Clínicamente, se caracteriza por la aparición de lesiones papulares y/o nodulares de una coloración rojiza-violeta con hipersensibilidad local. Se reporta el caso de una paciente femenina de 5 años, quien consultó por un cuadro clínico de 10 días de evolución de aparición de lesión forunculosa en el arco nasal. Se realizó una biopsia de piel, que reportó dermatitis difusa con predominio de polimorfonucleares neutrófilos, necrosis epidérmica y ausencia de vasculitis. No se identificaron microorganismos. Se consideró el cuadro compatible con síndrome de Sweet. Es importante tener en cuenta este diagnóstico en cuadros clínicos similares y se deben descartar otros diagnósticos más frecuentes primero.

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.

Síndrome de Sweet. Presentación de un caso y revisión de la literatura / Sweet syndrome. Case report and literature review

Se presentación el caso de una paciente femenina de 52 años con artralgias, fiebre de 39 grados, anorexia, conjuntivitis y lesiones eritemato-vesículo-pustulosas pruriginosas y dolorosas, asimétricas, en manos, brazos y espalda desde hace 3 días. En los exámenes de laboratorio los leucocitos se encontraban en 14.6 x 109 /L con 70 por ciento de neutrófilos, eritrosedimentación en 117 mm/h, la biopsia de piel evidenció dermatitis nodular y difusa, patrón Ackerman 7 concluyente para un síndrome de Sweet(AU)

We present the case of a female patient 52 year old with arthralgias, a fever of 39 degrees, anorexia, conjunctivitis, and pruritic and painful, asymmetric, erythematous-vesicular-pustular lesions on hands, arms and back for 3 days. In the laboratory tests the leukocytes were in 14.6 x 109 /L with 70 percent of neutrophils, erythrosedimentation in 117 mm / h, the skin biopsy showed nodular and diffuse dermatitis, Ackerman 7 pattern conclusive for a Sweet syndrome(AU)

Síndrome de Sweet en pediatría: a proposito de un caso / Sweet syndrome in pediatrics: a case report

INTRODUCCIÓN: El Síndrome de Sweet es una dermatosis muy infrecuente en pediatría, de patogenia desconocida, caracterizado clínicamente por fiebre, neutrofilia, placas solevantadas y dolorosas en piel de cara, cuello y extremidades e histológicamente por infiltración dérmica de neutrófilos. OBJETIVO: Presentación de un caso clínico de Síndrome de Sweet en paciente pediátrico. CASO CLÍNICO: Prees colar femenino de 3 años, portador de cromosomopatía compleja 46XX add(8). Consultó por cuadro clínico de 7 días de evolución caracterizado por placas y ampollas localizadas en dorso y posterior mente en extremidades, asociado a fiebre alta, sin respuesta a tratamiento antibiótico indicado por sospecha de impétigo ampollar. Al examen físico presentaba múltiples placas eritemato-violáceas, con centro ampollar en dorso, extremidades superiores e inferiores, junto a placas y nódulos eritematosos en brazo y muslo izquierdo. En los exámenes de laboratorio destacó leucocitosis con neutrofilia (RAN 45954/mm3) y PCR elevada (347 mg/L). Se realizó biopsia de lesiones cutáneas con hallazgos histopatológicos compatibles con Síndrome de Sweet. Se indicó tratamiento con prednisona 1 mg/ kg/día, con buena respuesta clínica. A las 2 semanas de tratamiento presentaba placas costrosas de menor tamaño, sin lesiones ampollares. CONCLUSIONES: El síndrome de Sweet corresponde a una dermatosis infrecuente en pediatría, por lo que se debe tener un alto índice de sospecha ante la presencia de fiebre asociado a lesiones cutáneas persistentes. Si bien la mayoría de los casos son idiopáticos, se debe realizar el tamizaje de condiciones asociadas, principalmente de trastornos proliferativos, infecciones e inmunodeficiencias.

INTRODUCTION: Sweet's syndrome is a very rare dermatosis in pediatrics, of unknown pathogenesis, clinically characterized by fever, neutrophilia, raised and painful plaques on the skin of the face, neck, and limbs, and histologically by dermal infiltration of neutrophils. OBJECTIVE: To present a clinical case of Sweet Syndrome in a pediatric patient. CLINICAL CASE: 3-years-old female child, with history of complex chromosomopathy 46XX add(8), with a 7-day history of plaques and blisters on the back and later also on the limbs, associated with high fever, without response to antibiotic treatment pres cribed due to suspicion of bullous impetigo. Physical examination showed multiple erythematous- violaceous plaques, with bullous center on the back, upper and lower limbs, along with plaques and erythematous nodules on the left arm and thigh. Laboratory tests showed leukocytosis with neutro philia (absolute neutrophil count 45954/mm3) and elevated CRP (347 mg/L). Biopsy of skin lesions reported histopathological findings compatible with Sweet's Syndrome. Treatment with prednisone 1 mg/kg/day was indicated with good clinical response. After two weeks of treatment, she presented crusty plaques of smaller size, without bullous lesions. CONCLUSIONS: Sweet's syndrome is an uncom mon dermatosis in pediatrics, therefore, a high index of suspicion should be held in the presence of fever associated with persistent skin lesions. While most cases are idiopathic, screening for associated conditions, mainly proliferative disorders, infections, and immunodeficiencies must be performed.

Síndrome de Sweet: revisión de la literatura a propósito de un caso / Sweet syndrome: review of the literature about a case

Sweet (SS) syndrome is a neutrophilic dermatosis, characterized by a rapid onset of painful erythematous-purplish papules, nodules or plaques, accompanied by fever and associated with a dermal neutrophil infiltrate. CASE REPORT: Male, 69 years old, with a history of mild plaque psoriasis, arterial hypertension, gastroesophageal reflux and chronic sinusitis. He consulted for a 24-hour period characterized by headache and pain in the scalp. The examination highlights fever (38.5°), with slight erythema, sensitivity to palpation and some psoriasis plaques on the scalp. 48 hours later, it presents extensive painful erythematouspurplish plaques, present only on his right face and scalp. Biopsy was informed as Sweet Syndrome. He completed 14 days on prednisone, with excellent clinical evolution. DISCUSSION Sweet syndrome is classified into three categories: classic or idiopathic (most common), drug induced and associated with malignancy. In addition, other conditions have been described which may be related to: infections, autoimmune diseases, pregnancy. The management is focused on investigating an underlying cause and the use of corticosteroids, as a first line therapy. We report a case of idiopathic Sweet syndrome with atypical presentation, which was initially interpreted as facial cellulitis, with a rapid response to systemic corticosteroids. (AU)

Type 2 leprosy reaction with Sweet's syndrome-like presentation

Abstract Leprosy is a chronic disease characterized by manifestations in the peripheral nerves and skin. The course of the disease may be interrupted by acute phenomena called reactions. This article reports a peculiar case of type 2 leprosy reaction with Sweet's syndrome-like features as the first clinical manifestation of leprosy, resulting in a delay in the diagnosis due to unusual clinical presentation. The patient had clinical and histopathological features reminiscent of Sweet's syndrome associated with clusters of vacuolated histiocytes containing acid-fast bacilli isolated or forming globi. Herein, it is discussed how to recognize type 2 leprosy reaction with Sweet's syndrome features, the differential diagnosis with type 1 leprosy reaction and the treatment options. When this kind of reaction is the first clinical presentation of leprosy, the correct diagnosis might be not suspected clinically, and established only with histopathologic evaluation.

Síndrome de Sweet asociado a síndrome mielodisplásico / Sweet syndrome associated with myelodysplastic syndrome

El síndrome de Sweet o dermatosis neutrofílica febril aguda es una enfermedad sistémica de etiología desconocida, caracterizada por aparición brusca de fiebre y lesiones cutáneas, asociadas con leucocitosis y neutrofilia. Puede ser idiopático o estar asociado a Enfermedades hematológicas, procesos inflamatorios, infecciones, fármacos o embarazo. Las mielodisplasias son trastornos hematológicos caracterizados por una o más citopenias secundarias a disfunción de la médula ósea. Presentamos el caso de un paciente de 81 años con síndrome de Sweet y posterior diagnóstico de síndrome mielodisplásico, con buena respuesta al tratamiento corticoideo y resolución de las lesiones cutáneas. (AU)

Sweet's syndrome or acute febrile neutrophilic dermatosis is a systemic disease of unknown etiology characterized by sudden onset of painful skin lesions; predominance of polymorphonuclear leukocytosis. It can be associated with hematologic malignancies, idiopathic, parainflammatory, secondary to drugs and pregnancy. Myelodysplasias are haematological disorders characterized by one or more cytopenias secondary to bone marrow dysfunction. We report the case of a patient of 81 years with Sweet syndrome with subsequent diagnosis of myelodysplastic syndrome with good response to corticosteroid treatment and resolution of the skin lesions. (AU)

An uncommon ocular manifestation of Sweet syndrome: peripheral ulcerative keratitis and nodular scleritis / Uma manifestação ocular rara de síndrome de Sweet: ceratite ulcerativa periférica e esclerite nodular

Sweet syndrome (acute febrile neutrophilic dermatosis) is characterized by fever, neutrophilic leukocytosis, and abrupt appearance of painful erythematous nodules and plaques, particularly on the face, neck, and limbs. In this study, we report a very rare case of Sweet syndrome in which the patient presented nodular scleritis and peripheral ulcerative keratitis during the dermatologically inactive period of the disease.

A síndrome de Sweet (dermatose neutrofílica febril aguda) é caracterizada por febre, leucocitose neutrofílica, aparecimento abrupto de nódulos eritematosos dolorosos e placas, principalmente na face, pescoço e membros. Neste artigo, relatamos um caso muito raro de síndrome de Sweet, que tinha esclerite nodular e ceratite ulcerativa periférica no período dermatologicamente inativo da doença.

Síndrome de Sweet y embarazo: a propósito de un caso / Sweet syndrome and pregnancy: case report

El síndrome de Sweet, también conocido como dermatosis neutrofílica febril aguda, es una entidad infrecuente, de etiología desconocida, caracterizada por la aparición brusca de placas eritematosas, dolorosas, acompañadas de fiebre, leucocitosis neutrofílica y denso infiltrado dérmico leucocitario polimorfonuclear. Si bien la mayoría de los casos son idiopáticos, es bienconocida su relación con procesos neoplásicos malignos, enfermedades autoinmunes, inflamatorias, infecciosas, fármacos y embarazo. Presentamos el caso de una paciente con síndrome de Sweet asociado a embarazo y realizamos una revisión bibliográfica de esta patología.

Sweet's syndrome, also known as acute febrile neutrophilic dermatosis, is a rare entity of unknown etiology characterized by the sudden onset of painful erythematous plaques, associated with fever, leukocytosis with neutrophilia as well as a dense dermal polymorphonuclear leukocytic infiltrate. Although most cases are idiopathic, it is well known to be related with malignant neoplastic processes, autoimmune, inflammatory, infectious diseases, drugs and pregnancy. A case of a pregnant woman with Sweet ́s syndrome diagnosis is reported and a literature review is performed.

Síndrome de Sweet idiopático: reporte de caso / Sweet syndrome idiopathic: case report

El síndrome de Sweet (SS) es el prototipo de las dermatosis neutrofílicas, un grupo de enfermedades cutáneas de carácter reactivo caracterizadas histopatológicamente por la presencia de un infiltrado de neutrófilos. Es un marcador de diversas enfermedades internas, entre las que destacan las infecciones, la enfermedad inflamatoria intestinal, las conectivopatías autoinmunitarias y variadas neoplasias malignas, especialmente las de origen hematológico. Se presenta el caso de una mujer de 39 años, con diagnóstico de SS, tras sospecha clínica y biopsia de lesiones cutáneas.

Sweet's syndrome (SS) is the prototype of neutrophilic dermatosis, a group of skin diseases reactive in nature and characterized histopathologically by the presence of an infiltrate of neutrophils. It is a marker of various internal diseases, among which are infections, inflammatory bowel disease, autoimmune connectivopathies and various malignancies, especially those oj hematologic origin. We present a case of a 39 year old woman, diagnosed with SS after clinical suspicion and biopsy of skin lesions.

Sweet’s syndrome.

Acute febrile neutrophilic dermatosis or Sweet’s syndrome (SS) is characterized by painful, erythematous plaques of rapid onset accompanied by fever. The etiology of SS is unknown and it may be associated with antecedent infections, malignancies, autoimmune diseases, drugs and vaccines, upper respiratory or gastrointestinal infection, pregnancy, inflammatory bowel disease as well as chemotherapy or idiopathic. The standard therapy for SS is systemic corticosteroids. We report a rare case of 19‑year‑old young male patient with complaint of severe ill‑defined type of pain in both jaws associated with plaques and papules on extensor surfaces of upper and lower extremities with bodyache and myalgia. Histopathological examination suggested perivascular neutrophilic infiltration with scattered eosinophils. Sweet syndrome has rare oral manifestations secondary to hematological changes. It can also present as a paraneoplastic syndrome (malignancy‑associated form of condition, which is most commonly related to acute myelogenous leukemia), which leads to poor prognosis and thus it requires careful examination, early diagnosis and long‑term follow‑up.