Recurrent Subcutaneous Sweet's Disease in a Myelofibrosis Patient Treated with Ruxolitinib before Allogeneic Stem Cell Transplantation

Sakoda, Teppei; Kanamitsu, Yoko; Mori, Yasuo; Sasaki, Kenji; Yonemitsu, Etsuko; Nagae, Konosuke; Yoshimoto, Goichi; Kamezaki, Kenjiro; Katô, Kôji; Takenaka, Katsuto; Miyamoto, Toshihiro; Furue, Masutaka; Iwasaki, Hiromi; Akashi, Koichi

doi:10.2169/internalmedicine.8491-16

Cited by 7 publications

(7 citation statements)

References 38 publications

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“…Five cases (36%) had a Naranjo score ≥ 5 indicating a probable drug‐induced etiology with supportive clinical details. One additional case had a Naranjo score of 4 but was also likely drug‐induced given that dose reduction and antibiotics failed to resolve the rash, but medication discontinuation and prednisolone did so rapidly 31 …”

Section: Resultsmentioning

confidence: 99%

“…Most convincingly, in two cases, the Sweet syndrome resolved with medication discontinuation but recurred with TKI re‐challenge without any further recurrence after permanent medication discontinuation 35,36 . In two other cases, Sweet syndrome began 7 to 8 weeks after TKI administration and was unsuccessfully treated with antibiotics or TKI dose reduction until medication discontinuation and systemic steroids rapidly resolved the rash, indicating a close temporal relationship suggestive of a drug‐induced etiology 31,37 . Yet another two cases described hematologic malignancies that had long been in remission prior to Sweet syndrome onset with no evidence of relapse on further workup 29,38 .…”

Section: Discussionmentioning

confidence: 98%

“…One additional case had a Naranjo score of 4 but was also likely drug-induced given that dose reduction and antibiotics failed to resolve the rash, but medication discontinuation and prednisolone did so rapidly. 31…”

Section: Application Of Inclusion Criteria Identified 14 Cases Of Tki...mentioning

confidence: 99%

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Sweet syndrome as an adverse reaction to tyrosine kinase inhibitors: A review

Yang

Maloney

Nguyen

et al. 2020

Dermatologic Therapy

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Tyrosine kinase inhibitors are a class of targeted anticancer drugs that inhibit cancer cell proliferation by inactivating proteins involved in signal transduction cascades. Various cutaneous adverse events have been observed after tyrosine kinase inhibitor administration, including Sweet syndrome. We queried the PubMed database to identify 14 cases of Sweet syndrome thought to be secondary to tyrosine kinase inhibitors. Tyrosine kinase inhibitor‐induced Sweet syndrome had a median of 2 months latency following drug administration. All cases but one had morphologic features classic for Sweet syndrome (erythematous and tender papules, plaques, or nodules). All cases also had classic histopathologic findings (dermal neutrophilic infiltrate without vasculitis or necrosis). Using diagnostic criteria for drug‐induced Sweet syndrome and the Naranjo Drug Reaction Probability Scale for a drug‐induced cutaneous eruption, we found that six cases favored a drug‐induced etiology over malignancy, two cases favored a malignancy‐associated Sweet syndrome, and the remaining eight met drug‐induced Sweet syndrome criteria but had low Naranjo scores. Nine cases resulted in medication discontinuation, while five cases continued anticancer therapy and were treated only with corticosteroids with quick resolution of skin lesions. Dermatologists should be aware of this adverse cutaneous reaction to tyrosine kinase inhibitors and should treat on a case‐by‐case basis, though limited evidence in this review suggests that oncologic therapy may safely be continued with prompt corticosteroid treatment.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 98%

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Sweet syndrome as an adverse reaction to tyrosine kinase inhibitors: A review

Yang

Maloney

Nguyen

et al. 2020

Dermatologic Therapy

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“…In the last six years, there have been four cases of Sweet syndrome (SS) reported in patients with ruxolitinib‐treated myelofibrosis. (1–4) To our knowledge, this is the first case reported on a ruxolitinib‐associated neutrophilic dermatosis presenting with a pathergy phenomenon at a post‐operative wound site, accompanied by mucosal involvement.…”

Section: Figurementioning

confidence: 87%

A neutrophilic dermatosis following treatment of myelofibrosis with ruxolitinib: An emerging phenomenon?

2021

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“…Although our patient's presentation was suggestive of NF with systemic involvement, her blood and wound cultures yielded no growth of infectious organisms, and she ultimately was diagnosed with necrotizing SS. Risk factors included our patient's history of acute myeloid leukemia and prior treatment with ruxolitinib, which has been reported to be associated with SS in patients with myelofibrosis [ 16 , 17 ]. With the lungs commonly being affected in systemic SS [ 13 ], her symptoms of cough and dyspnea, which did not improve with antibiotics and improved with systemic steroids, also support the diagnosis of necrotizing SS.…”

Section: Discussionmentioning

confidence: 99%

Necrotizing neutrophilic dermatosis: A diagnostic challenge with a need for multi-disciplinary recognition, a case report

Gowda

Christensen

Polly

et al. 2020

Annals of Medicine and Surgery

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Introduction Necrotizing neutrophilic dermatoses can clinically resemble necrotizing fasciitis and therefore pose a diagnostic and therapeutic challenge. Given their similar presentations, misdiagnosis and inappropriate or delayed treatments are possible. Presentation of case We discuss the case of a woman with acute myeloid leukemia who presented with fevers, chills, cough, and a leg wound. She underwent amputation of her lower extremity after she was presumed to have necrotizing fasciitis; however, symptoms persisted. She was ultimately diagnosed with and treated for necrotizing Sweet's syndrome with notable clinical improvement. Discussion Both, necrotizing neutrophilic dermatoses and necrotizing fasciitis, grossly affect the skin and are associated with rapidly progressing systemic features including fevers, chills, leukocytosis, and elevated inflammatory markers. Recent literature in dermatology addresses these similarities and the appropriate approach to management; however, it is critical that medical and surgical subspecialties have an understanding of necrotizing neutrophilic dermatoses and their clinical presentations, diagnostic approaches, as well as therapeutic interventions. Familiarity with this entity can mitigate the risk of misdiagnosis, morbidity, and mortality. Conclusion With this report, we seek to review the features that are suggestive of and aid in the diagnosis of necrotizing neutrophilic dermatoses to help prevent significant and avoidable morbidity.

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Recurrent Subcutaneous Sweet's Disease in a Myelofibrosis Patient Treated with Ruxolitinib before Allogeneic Stem Cell Transplantation

Cited by 7 publications

References 38 publications

Sweet syndrome as an adverse reaction to tyrosine kinase inhibitors: A review

Sweet syndrome as an adverse reaction to tyrosine kinase inhibitors: A review

A neutrophilic dermatosis following treatment of myelofibrosis with ruxolitinib: An emerging phenomenon?

Necrotizing neutrophilic dermatosis: A diagnostic challenge with a need for multi-disciplinary recognition, a case report

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