Sweet's syndrome associated with hematological malignancies

Leuk Res. 2020 Dec:99:106461. doi: 10.1016/j.leukres.2020.106461. Epub 2020 Oct 16.

Abstract

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.

Keywords: Acute febrile neutrophilic dermatosis; Acute myelogenous leukemia; Drug-induced Sweet's syndrome; Myelodysplastic syndrome; Necrotizing Sweet's syndrome; Neutrophilic dermatosis.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Anti-Inflammatory Agents / therapeutic use
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Biopsy
  • Delayed Diagnosis
  • Diagnostic Errors
  • Fatal Outcome
  • Febrile Neutropenia / diagnosis
  • Female
  • Glucocorticoids / therapeutic use
  • Humans
  • Leukemia, Myeloid, Acute / complications*
  • Leukemia, Myeloid, Acute / drug therapy
  • Leukemia, Myelomonocytic, Acute / complications
  • Leukemia, Myelomonocytic, Acute / drug therapy
  • Lymphoma, B-Cell, Marginal Zone / complications
  • Male
  • Middle Aged
  • Myelodysplastic Syndromes / complications*
  • Myelodysplastic Syndromes / drug therapy
  • Pyoderma Gangrenosum / diagnosis
  • Respiratory Tract Infections / complications
  • Skin / pathology
  • Sweet Syndrome / diagnosis
  • Sweet Syndrome / drug therapy
  • Sweet Syndrome / etiology*

Substances

  • Anti-Inflammatory Agents
  • Glucocorticoids