Sweet s syndrome

Indomethacin was particularly popular for gout and ankylosing spondylitis. In addition, it has been used to accelerate closure of patent ductus arteriosus. Indomethacin has been tried in numerous small or uncontrolled trials for many other conditions, including Sweet s syndrome, juvenile rheumatoid arthritis, pleurisy, nephrotic syndrome, diabetes insipidus, urticarial vasculitis, postepisiotomy pain, and prophylaxis of heterotopic ossification in arthroplasty. 

Sweet s syndrome (acute febrile neutrophilic dermatosis) has been attributed to an oral contraceptive (246). However, bearing in mind that the syndrome has a variable presentation and is thought to represent a form of hypersensitivity reaction, it is not at all clear that there was a true cause-and-effect relation. 

Saez M, Garcia-Bustinduy M, Noda A, Guimera F, Dorta S, Escoda M, Fagundo E, Sanchez R, Martin-Herrera A, Garcia Montelongo R. Sweet s syndrome induced by oral contraceptive. Dermatology 2002 204(1) 84. 

Sweet s syndrome has been reported several times in women taking oral contraceptives, but a well-documented recent case concerned the use of the Mirena uterine system for the administration of menorrhagia, where the... 

A 54-year-old woman fitted with a Mirena system soon developed fever and progressive skin lesions. A skin biopsy confirmed Sweet s syndrome. She was treatment with topical and oral glucocorticoids, but the condition relapsed on reduction of the dose. Her symptoms finally resolved on removal of the intrauterine system and she remained symptom free after 9 months. 

Eeckhout E, Willemsen M, Deconinck A, Somers G. Granulomatous vasculitis as a complication of potassium iodide treatment for Sweet s syndrome. Acta Dermatol Venereol 1987 67(4) 362 1. 

A 70-year-old white man, with no significant preceding medical history, developed an acute painful rash, a fever (38.4° C), and severe arthralgia 5 days after starting to take diazepam 10 mg bd for lumbar muscular contracture due to hard physical exercise. He had taken no other medications. There were well-defined purple-red skin plaques, surmounted by vesicular and hemorrhagic blisters. He had a leukocytosis. Sweet s syndrome was confirmed by punch biopsy of a lesion. Diazepam was withdrawn, and prednisolone 30 mg/day was given for 2 weeks and then tapered. The patient improved quickly and the eruption cleared in 10 days. 

A 27-year-old woman presented with a rapidly enlarging necrotic lesion on her face and left leg together with malaise and high fever (10). She reported that she had applied a 1.5% arnica cream to her face before these symptoms had occurred. The diagnosis was Sweet s syndrome elicited by pathergy to arnica. She was treated with prednisolone and her skin lesions disappeared within 3 weeks. 

Delmonte S, Brusati C, Parodi A, Rebora A. leukemia-related Sweet s syndrome elicited by pathergy to Arnica. Dermatology 1998 197(2) 195-6. 

Rashes or other aUergic-tjrpe cutaneous reactions are usually noted during the azathioprine hypersensitivity syndrome. Isolated but convincing reports point to the occurrence of vasculitis with microscopic polyarteritis (SEDA-21, 381) and Sweet s syndrome, which recurred after subsequent azathioprine exposure (SEDA-22, 410). 

Radeff B, Harms M. Acute febrile neutrophilic dermatosis (Sweet s syndrome) following BCG vaccination. Acta Derm Venereol 1986 66(4) 357-8. 

Sweet s syndrome can be associated with several drugs. 

A 57-year-old man developed the typical cutaneous erosions and plaques of Sweet s syndrome after taking celecoxib 100 mg bd for 1 week for bursitis. Celecoxib was withdrawn and the mucocutaneous lesions began to clear. However, the bursitis recurred and he restarted celecoxib. The cutaneous lesions worsened dramatically. After withdrawal of celecoxib for the second time the lesions cleared completely. 

Fye KH, Crowley E, Berger TG, LeBoit PE, Connolly MK. Celecoxib-induced Sweet s syndrome. J Am Acad Dermatol 2001 45(2) 300-2. 

A review of furosemide-induced skin reactions included a description of a unique case of an 88-year-old man who developed an eruption that clinically and histologically simulated Sweet s syndrome (acute febrile neutrophilic vasculitis) after 6 weeks (15). Atypical features and rapid resolution suggested a drug eruption rather than true Sweet s syndrome. However, a similar mechanism may have been implicated a hypersensitivity reaction involving immune complexes. 

Localized Sweet s sjmdrome can also occur (SEDA-20, 338). The spectrum of forms of G-CSF-induced neutrophilic dermatitis is wide. In two children with painful erythematous lesions attributed to G-CSF, histology showed microscopic, sterile, neutrophihc abscesses in one and neutrophihc pannicuhtis in the other (59). Other forms of neutrophihc dermatitis mentioned in G-CSF-treated patients have included isolated cases of bullous pyoderma gangrenosum and neutrophihc eccrine hidra-denitis (SEDA-21, 378) (SEDA-22, 408) (60). Sweet s syndrome has also been described in a case of hairy cell leukemia (61). 

Matzkies FG, Manger B, Schmitt-Haendle M, Nagel T, Kraetsch HG, Kalden JR, Schulze-Koops H. Severe septicaemia in a patient with polychondritis and Sweet s syndrome after initiation of treatment with infliximab. Aim Rheum Dis 2003 62(l) 81-2. 

Immunoallergic reactions have been reported with minocycline and include lupus-like syndrome, autoimmune hepatitis, eosinophilic pneumonia, hypersensitivity syndrome, a serum sickness-like illness (29), and Sweet s syndrome (SEDA-21, 262) (SEDA-22, 271). Over 60 minocycline-induced cases of lupus-like syndrome and 24 cases of minocycline-induced autoimmune hepatitis were found in a review of the literature (30). In 13 patients, both disorders co-existed. These patients had symmetrical polyarthralgia/polyarthritis, raised liver enzymes, and positive antinuclear antibodies they were also generally antihistone-negative, and only two patients had p-ANCA antibodies. Minocycline-related lupus can also occur in adolescents (31). 

Sweet s syndrome has been observed in association with a 7-day course of nitrofurantoin (73). 

Retief CR, Malkinson FD. Nitrofurantoin-associated Sweet s syndrome. Cutis 1999 63(3) 177-9. 

Maddox PR, Motley RJ. Sweet s syndrome a severe complication of pneumococcal vaccination following emergency splenectomy. Br J Surg 1990 77(7) 809-10. 

Acute febrile neutrophilic dermatosis (Sweet s syndrome) can occur in patients with acute promyelocytic leukemia given a retinoid. Sweet s syndrome is characterized by five cardinal features fever, neutrophilia, multiple raised painful asymmetric erythematous cutaneous plaques, dermal infiltrates consisting of mature neutrophils, and a rapid response to glucocorticoid therapy. In up to 10-20% of cases it precedes or coincides with a diagnosis of malignancy, most commonly acute myelogenous leukemia. In cases associated with tretinoin the symptoms come on at 7-34 days and the skin lesions are seen on the face, limbs, and back. 

Astudillo L, Loche F, Reynish W, Rigal-Huguet F, Lamant L, Pris J. Sweet s syndrome associated with retinoic acid syndrome in a patient with promyelocytic leukemia. Ann Hematol 2002 81(2) 111-14. 

Acute febrile neutrophilic dermatosis (Sweet s syndrome)... 

Acute febrile neutrophilic dermatosis (Sweet s syndrome) (2007) Clark BM +, Pharmacotherapy 27(9), I 343 Acute generalized exanthematous pustulosis (AGEP) (2006) Kapoor R+, Arch Dermatol 142(8), 1080 (2003) Valois M +, Contact Dermatitis 48(3), 169 Allergic reactions... 

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