Sweet's syndrome: clinicopathological features of patients treated from 1997 to 2009 at Cassiano Antonio Moraes University Hospital - Vitoria (Espirito Santo)

Abstract

Sweet's syndrome or acute febrile neutrophilic dermatosis is rare in Brazil. It is clinically characterized by painful erythematous nodules, papules or plaques that occur mainly on the neck and upper limbs. Its cause may be unknown (idiopathic form) or it may be associated with malignancies, usually hematologic, or drugs. The authors describe 16 cases of the syndrome. The median age was 36 years, and all patients were white and presented solid lesions, predominantly on the upper limbs and trunk. Histopathological examination of the dermis of all patients revealed predominance of moderate to intense, superficial and deep, diffuse inflammatory infiltrate, mainly consisting of polymorphonuclear neutrophils, with leukocytoclasia. It also revealed changes in the epidermis and hypodermis (neutrophilic hypodermitis), but with no signs of vasculitis in most patients, which was not considered an important finding for diagnosis. Presence of exocytosis of neutrophils was common, favoring the diagnosis of Sweet's syndrome when accompanied by diffuse interstitial neutrophilic dermatitis.

Sweet Syndrome: Clinical Features, Histopathology, and Associations of 83 Cases

“…Even though SS is also known as acute febrile neutrophilic dermatosis, our study obtained positive association with fever in only 32% of the cases, emphasising that fever is a minor criterion for SS, as pointed by Su and Liu 16 and von den Driesch. 17 Some studies obtained similar rates, 2,24,25,27 while others observed fever as a more frequent symptom in patients with SS. 26 Leukocytosis and neutrophilia were commonly observed in our cohort, which was consistent with data previously published.…”

“…26 Leukocytosis and neutrophilia were commonly observed in our cohort, which was consistent with data previously published. 24,27 Inflammatory tests, such as CRP and ESR, presented high values in most cases. Interestingly, we observed that malignancy was associated with higher levels of ESR.…”

“…26 Leukocytosis and neutrophilia were commonly observed in our cohort, which was consistent with data previously published. 24,27…”

Sweet or Not? Azathioprine-Induced Sweet Syndrome Mimicking Erythema Nodosum in a Patient With Inflammatory Bowel Disease

“…10 Sweet syndrome and EN exhibit several analogous clinical and histological characteristics. 11,12 Both conditions share the feature of acute onset and can be linked to similar systemic factors, including upper respiratory infections, certain medications, hematologic malignancies, and autoimmune diseases. 13,14 Both SS and EN are commonly managed with rapid initiation of glucocorticoids.…”

Concurrence of Sweet's Syndrome, Pathergy Phenomenon and Erythema Nodosum-like Lesions

“…Sweet's syndrome and erythema nodosum share many similar clinical and histological features. 1 - 3 , 7 , 8 Both have acute onset and occur in association with many of the same systemic conditions, such as upper respiratory infections, medications, hematologic malignancies, and autoimmune disease. 2 , 5 , 8 The two conditions are responsive to similar therapeutic drugs as systemic glucocortioids or potassium iodide.…”