Sweet's syndrome type leprosy reaction

Aires, Nádia Barbosa; Loureiro, Walter Refkalefsky; Villela, Marreiro; Valente, Neusa Yuriko Sakai; Trindade, Maria Ângela Bianconcini

doi:10.1111/j.1468-3083.2008.02893.x

Cited by 6 publications

(6 citation statements)

References 9 publications

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“…Sweet's syndrome-like leprosy reaction is more easily recognized in patients with leprosy already diagnosed than in those without previous diagnosis of the baseline disease. 10 In this case, the use of oral corticosteroids for asthma treatment resulted in partial and intermittent reversal of reaction feature and possibly contributed to the delay in the diagnosis. Although the patient did not present skin lesions and neurological changes suggestive of leprosy, chronic clinical setting and the presence of lesions similar to those of Sweet's syndrome disseminated over the body helped in diagnostic elucidation.…”

Section: Discussionmentioning

confidence: 83%

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Type 2 leprosy reaction with Sweet's syndrome-like presentation

Chiaratti

Daxbacher

Neumann

et al. 2016

An. Bras. Dermatol.

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Leprosy is a chronic disease characterized by manifestations in the peripheral nerves and skin. The course of the disease may be interrupted by acute phenomena called reactions. This article reports a peculiar case of type 2 leprosy reaction with Sweet's syndrome-like features as the first clinical manifestation of leprosy, resulting in a delay in the diagnosis due to unusual clinical presentation. The patient had clinical and histopathological features reminiscent of Sweet's syndrome associated with clusters of vacuolated histiocytes containing acid-fast bacilli isolated or forming globi. Herein, it is discussed how to recognize type 2 leprosy reaction with Sweet's syndrome features, the differential diagnosis with type 1 leprosy reaction and the treatment options. When this kind of reaction is the first clinical presentation of leprosy, the correct diagnosis might be not suspected clinically, and established only with histopathologic evaluation.

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Section: Discussionmentioning

confidence: 83%

“… 9 - 13 It is classified as a subtype of type 2 reaction and occurs more often in borderline-lepromatous patients. 10 …”

Section: Discussionmentioning

confidence: 99%

Type 2 leprosy reaction with Sweet's syndrome-like presentation

Chiaratti

Daxbacher

Neumann

et al. 2016

An. Bras. Dermatol.

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“…Atypical ENL lesions were predominant in male patients with an approximate male to female ratio of 2.7 : 1 and an age range of 10–73 years with a mean ± standard deviation (SD) of 41.5 ± 44.5. A list of reported cases of atypical ENL is demonstrated in Table 1 [4–59].…”

Section: Resultsmentioning

confidence: 99%

Atypical presentations of erythema nodosum leprosum: Diagnostic and therapeutic aspects

Alakad

Nofal

Assaf

2021

J Deutsche Derma Gesell

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Summary Classic erythema nodosum leprosum (ENL) is characterized clinically by abrupt eruption of tender erythematous nodules, papules and plaques. Variable atypical patterns have been described, for example pustular, bullous, ulcerative, necrotic and Sweet’s syndrome‐like ENL. We aim to review previously reported cases of atypical ENL addressing the diagnostic and therapeutic aspects of these uncommon presentations. A search of medical literature for all cases of atypical ENL was conducted in the PubMed database till 2020. Data of patients with atypical ENL were collected and analyzed to describe the epidemiological, clinico‐histological and therapeutic features. The major five clinically described presentations of atypical ENL include vesiculo‐bullous lesions (46 % of patients), ulcero‐necrotic lesions (41 %), erythema multiforme‐like lesions (28 %), Sweet’s syndrome‐like lesions (11 %) and pustules (9 %). The skin lesions were accompanied by fever and constitutional symptoms in all patients. Oral steroids and thalidomide were the main lines of therapy in most of the reported patients. Dermatologists and pathologists should keep in mind the clinical variability of ENL to avoid misdiagnosis and delayed management. Early recognition can help control disease progression and save the patients from further complications.

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“…As he did not have a preceding diagnosis of leprosy, this was an unexpected finding. Most reported cases mimicking Sweet’s syndrome have prior diagnosis of borderline or lepromatous leprosy 6 …”

Section: Discussionmentioning

confidence: 99%

Lepromatous leprosy in erythema nodosum leprosum reaction mimicking Sweet’s syndrome

et al. 2011

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A 52-year-old Malay man presented with an acute one week history of multiple erythematous papules and nodules on the limbs, trunk, and face. On physical examination, he had multiple erythematous nontender, nonpruritic nodules and plaques on the trunk, limbs, and forehead ( Fig. 1). A few nodules showed pustulation and ulceration ( Fig. 2). He was febrile at 38°C. Systemic review and general examination were normal. There were no thickened nerves, neurological deficits, or deformities of the hands or feet. Eyes and oral mucosa were normal.The initial clinical impression was that of Sweet's syndrome in view of the acute onset of typical lesions and fever. Complete blood count revealed marked leukocytosis (24.1 · 10 3 /ll) with predominant neutrophilia (87.5%). Erythrocyte sedimentation rate (ESR) was markedly raised. Differential diagnoses included cutaneous lymphoma and infective causes, such as cutaneous tuberculosis, multibacillary leprosy, and nontuberculous mycobacterial or subcutaneous fungal infection.Skin biopsy confirmed the diagnosis of lepromatous leprosy with erythema nodosum leprosum reaction. The histology showed a Grenz zone with granulomas throughout the dermis, consisting of foamy macrophages with globi of bacilli within. Focal areas showed thrombosed vessels with necrosis of vessel walls and numerous neutrophils. Fite stain was positive for leprae bacilli (Fig. 3). Direct immunofluorescence showed granular deposits of IgA and C3 in the upper and lower dermal blood vessel walls, consistent with vasculitis.Slit skin smear confirmed the presence of Mycobacterium leprae with a Bacteriological Index of 5+ and a Morphological Index of <1%. DiscussionLeprosy has been controlled in Singapore for many years. This has been achieved by a good program for control of Figure 1 Erythematous plaques and nodules on the trunk Figure 2 Erythematous plaque with pustule and healing ulcer

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Sweet's syndrome type leprosy reaction

Cited by 6 publications

References 9 publications

Type 2 leprosy reaction with Sweet's syndrome-like presentation

Type 2 leprosy reaction with Sweet's syndrome-like presentation

Atypical presentations of erythema nodosum leprosum: Diagnostic and therapeutic aspects

Lepromatous leprosy in erythema nodosum leprosum reaction mimicking Sweet’s syndrome

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