Diffuse febrile dermatosis in a patient with active ulcerative colitis under treatment with steroids and azathioprine: a case of Sweet’s syndrome

Paoluzi, O.A.; Crispino, Pietro; Amantea, A.; Pica, Roberta; Iacopini, Federico; Consolazio, A.; Palma, Veronica Di; Rivera, M.; Paoluzi, P.

doi:10.1016/j.dld.2003.10.020

Cited by 33 publications

(32 citation statements)

References 40 publications

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“…Many patients with IBD are treated with AZA as a corticosteroid-sparing agent. 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].…”

Section: Discussionmentioning

confidence: 99%

“…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%

“…More recently azathioprine (AZA), the nitroimidazole of 6-mercaptopurine, which is widely used as a corticosteroid-sparing agent in a variety of autoimmune inflammatory diseases, has been increasingly reported as a potential cause of SS [4,5,6,7,8,9,10,11,12,13,14]. Here we report a severe case of SS associated with AZA therapy, review the literature concerning similar cases reported to date and analyze the expression of the proinflammatory cytokine interleukin-1β (IL-1β) in our patient's skin lesions.…”

Section: Introductionmentioning

confidence: 99%

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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

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Case Descriptionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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

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“…8 Neutrophilic dermatoses such as Sweet syndrome and pyoderma gangrenosum have been described as secondary to azathioprine therapy in inflammatory bowel disease. 12 Neutrophilic dermatosis may be secondary to a pharmacological effect of azathioprine. The histological findings of the pustular rash with neutrophilic infiltration could be compatible with such a diagnosis.…”

Section: Commentmentioning

confidence: 99%

Erythema Nodosum–like Eruption as a Manifestation of Azathioprine Hypersensitivity in Patients With Inflammatory Bowel Disease

Fonclare¹,

Khosrotehrani²,

Aractingi³

et al. 2007

Arch Dermatol

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Background: Clinical manifestations of hypersensitivity to azathioprine may mimic symptoms of the initial disease. We report 5 cases of peculiar skin hypersensitivity reactions to azathioprine in patients with inflammatory bowel disease.Observations: In 5 patients with a recent azathioprine regimen, manifestations appeared between 8 and 18 days after drug introduction. All patients had a high fever. Three patients initially had erythema nodosum; 2 patients had sterile pustules. All had elevated neutrophil counts and serum C-reactive protein levels, whereas eosinophil counts were normal, ruling out druginduced rash with eosinophilia and systemic symp-toms. In 3 patients who were rechallenged with azathioprine or with 6-mercaptopurine, dermatological lesions recurred within hours.Conclusions: Erythema nodosum and pustules are rarely reported manifestations of azathioprine hypersensitivity. Both skin lesions may be related to the clinical activity of inflammatory bowel disease. Relapse of such lesions shortly after thiopurine rechallenge should raise the hypothesis of hypersensitivity rather than pharmacological manifestations.

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Assessing the Patient With Arthralgia, Fevers, and Rash—In Reply

Ardalan

Vasudevan

Testro

2016

JAMA

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Both scenarios imply that the average GRS-BMI should be lower for study participants in earlier birth cohorts. However, we showed (Table 2 in the article and eTable 1 in the Supplement) that genetic risk remained stable across the birth cohorts, despite major changes in BMI. Furthermore, GRS-BMI did not predict mortality for white participants in HRS (P = .45). Additionally, we estimated a model testing whether the birth year by GRS-BMI interaction differed for white respondents above or below age 65 years and found no evidence of such effect modification by age (P = .24).With respect to Mr Liu and Dr Guo, upon reviewing their article, 6 we agree that our results for white respondents substantially overlap with theirs. This type of overlap is always a risk with publicly available data sets such as the HRS, but missing their citation was a mistake on our part. Our manuscript was mostly finished prior to their publication (first full draft completed March 2014). We attempted to update our literature review, but we failed to identify this important publication. We apologize for our error. We consider it an indication of the importance of this research question that it was undertaken by multiple independent research groups, and we are pleased that the findings are consistent.

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Diffuse febrile dermatosis in a patient with active ulcerative colitis under treatment with steroids and azathioprine: a case of Sweet’s syndrome

Cited by 33 publications

References 40 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

Erythema Nodosum–like Eruption as a Manifestation of Azathioprine Hypersensitivity in Patients With Inflammatory Bowel Disease

Assessing the Patient With Arthralgia, Fevers, and Rash—In Reply

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