A Neutrophilic Reaction of Sweet's Syndrome Type Associated With the Oral Contraceptive

Abstract

A case is presented of a Sweet's syndrome-like eruption in association with the oral contraceptive. A 46 year old caucasian woman developed recurrent episodes of erythematous tender plaques on her trunk six weeks after commencement of the oral contraceptive (OC). Her condition clinically and histologically resembled Sweet's dermatosis. On cessation of the OC there was complete resolution of her lesions and she remains well 12 months later. This is the first report, to our knowledge, of a neutrophilic reaction to the oral contraceptive, and we believe that drugs may be implicated in the aetiology of atypical neutrophilic reactions simulating Sweet's syndrome in patients who are otherwise well.

Sweet's syndrome – a comprehensive review of an acute febrile neutrophilic dermatosis

“…However, eosinophils have been observed within the dermal infiltrate in the Sweet's syndrome skin lesions of some patients with either the classical [11,167,168,195,202-204,212] or the drug-induced [84,107,110,111] dermatosis. Occasionally, lymphocytes or histiocytes may also be present in the inflammatory infiltrate [11,104,167,168,198-200,425].…”

Diazepam‐associated Sweet's syndrome

“…SS has been understood as a direct response to mechanical and chemical irritants, as an infectious disease, or as a disorder of neutrophilic chemotaxis and/or phagocytosis, but often it has been described as a hypersensitivity reaction. 2–15 In this sense, histologic, immunohistochemical and immunofluorescence microscopy studies have supported a type III hypersensitivity reaction and a T cell‐dependent cellular immune reaction 11–19 . 23 Among those drug‐induced cases reported in the literature, the average time from the initiation of drug therapy to the onset of clinical symptoms, is found to be around 7.5 days.…”

“… 1 It is an uncommon acute disorder frequently associated with a great variety of diseases, such us underlying malignancies (mainly hematological), autoimmune and inflammatory disorders, previous respiratory or gastrointestinal infections and pregnancy 2,3 . Infrequently, it has been also atributed to medications, including trimethoprim‐sulfamethoxazole, 4 minocycline, 5,6 oral contraceptives, 7 all‐ trans‐ retinoic acid, 8,9 , 10 granulocyte colony‐stimulating factor, 11,12 , 13,14 furosemide, 15 hydralazine, 16 lithium, 17 diclofenac, 18 and nitrofurantoine. 19…”

Sweet’s Syndrome Induced by Oral Contraceptive

“…Only a single case in which Sweet's syndrome was believed to be precipitated by oral contraceptives could be found [2]. Nevertheless as more cases of drug-induced Sweet's syndrome are being reported in the literature, we suggest that a drug aetiology should be sought in cases of Sweet's syndrome and we recommend that a careful drug history should be included in the assessment of all the cases of this syndrome.…”

“…Only 1 case of Sweet's syndrome associated with oral contraceptives has been found in the literature [2].…”