Azathioprine-induced acute febrile neutrophilic dermatosis (Sweet's syndrome)

Grelle, Jennifer L.; Halloush, Ruba A; Khasawneh, Faisal A

doi:10.1136/bcr-2013-200405

Cited by 11 publications

(7 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…When SS occurs in such patients, IBD is the first suspected cause of the syndrome, given the well-reported association [10,15]. However, in the last few years several papers reporting a possible association between AZA and SS have been published (table 2) [4,5,6,7,8,10,11,12,13,14,15,16,17]. Interestingly, two of the cases reporting AZA-associated SS had an underlying disease other than IBD, and rechallenge of patients with AZA reproduced SS lesions in all 6 cases rechallenged, both facts providing support for a potential role of AZA as a trigger/co-factor in certain cases of SS [4,7].…”

Section: Discussionmentioning

confidence: 99%

“…A very recent review of the literature up to the 30th of May 2014 identified 16 reported cases of AZA-induced SS (table 2) [4,5,6,7,8,10,11,12,13,14,15,16,17]. Analysis of these 16 reported cases shows an age distribution upon onset ranging from 9 to 89 years, an association of AZA-induced SS with IBD in 13 of 16 cases (81%), and an onset within the first month of AZA therapy (with an average time to onset of 33 days, range 7-330) in 15 of 16 patients (94%) (table 2).…”

Section: Case Descriptionmentioning

confidence: 99%

See 1 more Smart Citation

Severe Sweet's Syndrome with Elevated Cutaneous Interleukin-1β after Azathioprine Exposure: Case Report and Review of the Literature

Imhof¹,

Meier²,

Frei

et al. 2015

Dermatology

View full text Add to dashboard Cite

Sweet's syndrome (SS) is a dermatosis with systemic symptoms characterized by tender, red nodules or papules, occasionally covered with vesicles, pustules or bullae, usually affecting the upper limbs, face and neck. SS is frequently observed in patients with leukemia or connective tissue diseases, while it is rather seldom in patients with inflammatory bowel disease. The exact pathogenesis of SS is only partially understood. We report the case of a 50-year-old patient with indeterminate colitis, presenting with a febrile diffuse papulopustular and necrotizing skin eruption that healed with significant scarring and appeared 14 days after onset of treatment with azathioprine. Histological examination revealed the presence of features typical of SS, gene expression analysis very high levels of interleukin-1β (IL-1β) mRNA in lesional skin, and immunohistochemistry high levels of IL-1β at the protein level. SS associated with azathioprine is being increasingly reported and is reviewed herein.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Case Descriptionmentioning

confidence: 99%

Severe Sweet's Syndrome with Elevated Cutaneous Interleukin-1β after Azathioprine Exposure: Case Report and Review of the Literature

Imhof¹,

Meier²,

Frei

et al. 2015

Dermatology

View full text Add to dashboard Cite

show abstract

“…Rechallenge is contraindicated due to the risk of greater morbidity and mortality. 19,24 Patients should be advised to avoid other purine analogues such as mercaptopurine 15,19 due to potential cross-reactivity.…”

Section: Discussion and Review Of The Literaturementioning

confidence: 99%

Azathioprine‐induced Sweet's syndrome: A case series and review of the literature

2015

View full text Add to dashboard Cite

We present three patients with azathioprine-induced Sweet's syndrome (AISS) who attended our tertiary institution within a 12-month period. Established associations exist between Sweet's syndrome and some medications; however, to date links to azathioprine are tentative. While there are case reports of AISS, most have occurred in patients with inflammatory bowel disease (IBD), an underlying predisposition for Sweet's syndrome. Our case series adds to the evidence that the entity of AISS truly exists independent of confounding factors such as concurrent IBD.

show abstract

“…Azathioprine hypersensitivity syndrome may mimic an acute neutrophilic dermatosis. It is typically reversible on azathioprine cessation [ 1 , 4 ], but subsequent avoidance is crucial as rechallenge can lead to a more severe adverse reaction and even death [ 1 , 6 ]. Therefore, it requires prompt diagnosis and must be distinguished from neutrophilic dermatosis associated with inflammatory bowel disease.…”

Section: Discussionmentioning

confidence: 99%

“…The cessation of azathioprine and the treatment with oral steroids led to a complete remission in all cases reported [ 1 , 2 ]. Rechallenge with azathioprine is not recommended [ 3 , 4 ]. We present here 2 cases of azathioprine hypersensitivity syndrome in patients with ulcerative colitis.…”

Section: Introductionmentioning

confidence: 99%

Azathioprine Hypersensitivity Syndrome: Two Cases of Febrile Neutrophilic Dermatosis Induced by Azathioprine

et al. 2017

View full text Add to dashboard Cite

Background: Azathioprine is an immunosuppressive agent used in the treatment of immune-mediated diseases. Azathioprine hypersensitivity syndrome is a rare adverse reaction occurring a few days to weeks after the administration of azathioprine. Case 1: A 36-year-old male with ulcerative colitis presented with erythematous plaques, pustules and erosions on the lower back, buttocks and thighs associated with high fever (39°C) 2 weeks after the initiation of azathioprine 100 mg/day. Additional findings included leukocytosis (18.6 g/L) with neutrophilia (11.1 g/L) and elevated C-reactive protein (128 mg/L). Histopathology showed a dense infiltrate of neutrophils in the hair follicles. We increased the dose of prednisone to 1 mg/kg/day (60 mg/day) and azathioprine was discontinued. He had marked improvement within 3 weeks and did not have any relapse with a 1-year follow-up. Case 2: A 57-year-old male with ulcerative colitis presented with erythematous plaques and pustules on the lower limbs associated with high fever (40°C) 1 week after the initiation of azathioprine 75 mg/day. Leukocytosis with neutrophilia (13.6 g/L) and elevated C-reactive protein (344 mg/L) were among the laboratory findings. Histopathology showed a dense infiltrate of neutrophils in the hair follicles. The dose of prednisone was increased to 20 mg/day and azathioprine was discontinued, which led to complete remission within 7 days. He did not have any relapse with a 6-month follow-up. Conclusion: The development of acute neutrophilic dermatitis 2 weeks after the initiation of azathioprine and the complete resolution after its withdrawal were in favor of azathioprine hypersensitivity syndrome. It should not be confused with Sweet syndrome associated with inflammatory bowel disease, as maintenance of azathioprine treatment may lead to life-threatening reactions.

show abstract

Azathioprine-induced acute febrile neutrophilic dermatosis (Sweet's syndrome)

Cited by 11 publications

References 3 publications

Severe Sweet's Syndrome with Elevated Cutaneous Interleukin-1β after Azathioprine Exposure: Case Report and Review of the Literature

Severe Sweet's Syndrome with Elevated Cutaneous Interleukin-1β after Azathioprine Exposure: Case Report and Review of the Literature

Azathioprine‐induced Sweet's syndrome: A case series and review of the literature

Azathioprine Hypersensitivity Syndrome: Two Cases of Febrile Neutrophilic Dermatosis Induced by Azathioprine

Contact Info

Product

Resources

About