Atypical Neutrophilic Dermatosis on the Upper Extremity Affected by Postmastectomy Lymphedema: Report of 2 Cases

Demitsu, Toshio; Tadaki, Teiriki

doi:10.1159/000247677

Cited by 43 publications

(22 citation statements)

References 6 publications

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“…The development of Sweet's syndrome after prior operative procedures has been reported in two patients after mastectomy, and was ascribed to the presence of lymphedema in both. 18 A similar syndrome has been encountered 3 months after a proctocolectomy for ulcerative colitis, and was thought to be unrelated to the operative treatment. 17 Postoperative injuries to the skin at the site of a Bovie electrocautery electrode are rarely reported, and primarily represent cutaneous burn injuries.…”

Section: Discussionmentioning

confidence: 87%

Acute Postoperative Dermatosis at the Site of the Electrocautery Pad: Sweet Diagnosis of a Burning Issue

2000

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Acute febrile neutrophilic dermatosis or Sweet's syndrome is a well-described acute condition with possible paraneoplastic and inflammatory associations. A case of a 49-year-old man with a prior history of Hodgkin's disease is described, who underwent a laparotomy for operative treatment of a small intestinal stricture and therapy-refractory gastroesophageal reflux. Incidentally, mild mesenteric lymphadenopathy was encountered, and a biopsy confirmed the presence of a new, unrelated low-grade follicular lymphoma. Two weeks postoperatively, the patient developed a tender erythematous plaque at the site of the Bovie electrocautery pad on the proximal thigh. Over the following week, the affected area extended in size, and became markedly edematous and infiltrated, with hemorrhagic surface studding. Multiple small plaques, some with annular arrays of pustules, were found on the opposite lower extremity, the lower back, and the arms. A skin biopsy suggested the presence of Sweet's syndrome, and corticosteroid treatment was initiated. All cutaneous manifestations disappeared within 48 h except for the presence of postinflammatory erythema. Acute neutrophilic dermatoses have not been previously described in this postoperative presentation. The differential diagnostic importance of this emergent entity and the potential for it being caused by surgical trauma are discussed.

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Section: Discussionmentioning

confidence: 87%

Acute Postoperative Dermatosis at the Site of the Electrocautery Pad: Sweet Diagnosis of a Burning Issue

2000

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“…Lesions have also been photodistributed (Figures 3a and 3b) or localized to the site of a prior phototoxic reaction (sunburn) in some Sweet's syndrome patients [13,20,98,143-145]. Occasionally, Sweet's syndrome lesions have appeared on the arm affected by postmastectomy lymphedema [100,146,414]. …”

Section: Clinical Descriptionmentioning

confidence: 99%

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

Cohen

2007

Orphanet J Rare Dis

737

1,006

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“…Since the lymphatic system controls important immunological functions, it is clear that, whatever the cause, inadequate lymph drainage of a given region makes it an immunologically vulnerable area, 1,2 i.e. a privileged site for a subsequent development of immunocompetencerelated diseases, such as tumours, infections, and immune disorders [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] (Table 2).…”

Section: Regional Chronic Lymphoedemamentioning

confidence: 99%

“…Among the immunity-related disorders selectively occurring on long-standing lymphoedematous areas, we are aware of several cases of Sweet's syndrome, 16,17 three cases of bullous pemphigoid, [18][19][20] and one report of ampicillin-induced toxic epidermal necrolysis. 21 In all three cases, bullous pemphigoid appeared at the site of previous irradiation that had been complicated by the onset of local lymphoedema.…”

Section: Infections and Immune Disordersmentioning

confidence: 99%

The immunocompromised district: a unifying concept for lymphoedematous, herpes‐infected and otherwise damaged sites

Ruocco¹,

Brunetti

Puca

et al. 2009

Acad Dermatol Venereol

206

275

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Systemic immunodeficiency is known to facilitate the onset of opportunistic infections, tumours and immune disorders in any district of the body. There are clinical events, such as chronic lymphoedema, herpetic infections, vaccinations and heterogeneous physical injuries which can selectively damage and immunologically mark the cutaneous district they act upon. After the causing event has disappeared, the affected district may appear clinically normal, but its immune behaviour is often compromised forever. An immunocompromised district becomes a site which is particularly susceptible to subsequent outbreaks of opportunistic infections, tumours and immune disorders confined to the district itself. In this review, there is an ample case-report collection of opportunistic disorders (infectious, neoplastic, immune) which appeared in immunocompromised districts. The cases have been grouped according to the clinical settings responsible for the local immune imbalance: regional chronic lymphoedema; herpes-infected sites, which feature the well-known Wolf's isotopic response; and otherwise damaged areas, comprising sites of vaccination, ionizing or UV radiation, thermal burns and traumas. Whatever the immunocompromising factor, a common denominator which facilitates the occurrence of tumours, infections and dysimmune reactions in an immunocompromised district may reside in locally hampered lymph drainage and/or locally altered neuromediator signalling. In fact, any obstacle to the normal trafficking of immunocompetent cells through lymphatic channels or any interference with the signals that the neuropeptides and neurotransmitters released by peripheral nerves send to cell membrane receptors of immunocompetent cells, can significantly alter the local immune response, thus paving the way for heterogeneous opportunistic disorders in the immunocompromised district.

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Atypical Neutrophilic Dermatosis on the Upper Extremity Affected by Postmastectomy Lymphedema: Report of 2 Cases

Cited by 43 publications

References 6 publications

Acute Postoperative Dermatosis at the Site of the Electrocautery Pad: Sweet Diagnosis of a Burning Issue

Acute Postoperative Dermatosis at the Site of the Electrocautery Pad: Sweet Diagnosis of a Burning Issue

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

The immunocompromised district: a unifying concept for lymphoedematous, herpes‐infected and otherwise damaged sites

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