Type 2 leprosy reaction resembling Sweet syndrome: Review of new and published cases

Chávez‐Álvarez, Sonia; Herz‐Ruelas, Maira Elizabeth; Ocampo‐Candiani, Jorge; Gómez‐Flores, Minerva

doi:10.1111/ajd.13224

Cited by 10 publications

(9 citation statements)

References 9 publications

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“…Intense dermal edema in ENL can lead to a pseudovesicular pattern which gives resemblance to Sweet's syndrome. The pathological findings are quite similar to Sweet's syndrome as well, with dense infiltration of either intact or fragmented neutrophils in the superficial and middle dermis [58]. Sweet's syndrome-like ENL was reported in 11 % of the atypical cases.…”

Section: Clinical Features Of Atypical Enlsupporting

confidence: 67%

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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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Section: Clinical Features Of Atypical Enlsupporting

confidence: 67%

“…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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“…In recent literature, SS has been reported to mimic cutaneous T-cell lymphoma [101], leprosy [102][103][104], leukemia cutis [105,106], Mycobacterium haemophilum infection [107], RAS-associated autoimmune leukoproliferative disease, rheumatoid neutrophilic dermatoses [108], secondary syphilis [109], and synovitis acne pustulosis hyperostosis syndrome [110]. Conversely, SS has been reported to be mimicked by cutaneous metastasis [111] and rosacea-like dermatitis [63].…”

Section: Differential Diagnosismentioning

confidence: 99%

New Practical Aspects of Sweet Syndrome

et al. 2022

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Sweet syndrome (SS), or acute febrile neutrophilic dermatosis, is an inflammatory, non-infectious skin reaction characterized clinically by tender, erythematous papules/plaques/pustules/nodules commonly appearing on the upper limbs, trunk, and head and neck; histologically, SS is characterized by dense neutrophilic infiltrate in the dermis. SS is accompanied by fever; an elevation of inflammatory markers (e.g., erythrocyte sedimentation rate, C reactive protein) in serum may also be observed. Although most cases of SS are idiopathic, SS also occurs in the setting of malignancy or following administration of an associated drug. SS has also been reported in association with pregnancy and a burgeoning list of infectious (most commonly upper respiratory tract infections) and inflammatory diseases; likewise, the litany of possible iatrogenic triggers has also grown. Over the past several years, a wider spectrum of SS presentation has been realized, with several reports highlighting novel clinical and histological variants. Corticosteroids continue to be efficacious first-line therapy for the majority of patients with SS, although novel steroid-sparing agents have been recently added to the therapeutic armamentarium against refractory SS. New mechanisms of SS induction have also been recognized, although the precise etiology of SS still remains elusive. Here, we catalogue the various clinical and histological presentations of SS, summarize recently reported disease associations and iatrogenic triggers, and review treatment options. We also attempt to frame the findings of this review in the context of established and emerging paradigms of SS pathogenesis.

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“…Der Altersbereich war 10–73 Jahre bei einem Mittelwert ± Standardabweichung von 41,5 ± 44,5. Die dokumentierten Fälle eines atypischen ENL sind in Tabelle 1 aufgelistet [4–59].…”

Section: Ergebnisseunclassified

“…Stark ausgeprägte dermale Ödeme beim ENL können ein pseudovesikuläres Muster hervorrufen, das dem Sweet‐Syndrom ähnelt. Auch die pathologischen Befunde ähneln dem Sweet‐Syndrom mit dichtem Infiltrat intakter oder fragmentierter Neutrophiler in der oberen und mittleren Dermis [58]. Ein Sweet‐Syndrom‐artiges ENL wurde in 11 % der atypischen Fälle dokumentiert.…”

Section: Diskussionunclassified

Atypisches Erythema nodosum leprosum: Diagnostische und therapeutische Aspekte

Alakad

Nofal

Assaf

2021

J Deutsche Derma Gesell

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ZusammenfassungDas klassische Erythema nodosum leprosum (ENL) ist klinisch durch plötzliches Auftreten druckempfindlicher erythematöser Knoten, Papeln und Plaques charakterisiert. Daneben wurden verschiedene atypische Muster, wie pustulöses, bullöses, ulzeriertes, nekrotisches und Sweet‐Syndrom‐artiges ENL beschrieben. Wir geben eine Übersicht bisher dokumentierter Fälle atypischer ENL und gehen dabei auf diagnostische und therapeutische Aspekte dieser selteneren Formen ein. Dazu wurde die medizinische Literatur in der Datenbank PubMed nach allen Fällen atypischer ENL bis zum Jahr 2020 durchsucht. Die Daten von Patienten mit atypischem ENL wurden erfasst und hinsichtlich epidemiologischer, klinisch‐histologischer und therapeutischer Aspekte analysiert. Die fünf hauptsächlich beschriebenen klinischen Formen des atypischen ENL sind vesikulär‐bullöse (46 % der Patienten), ulzerös‐nekrotische (41 %), Erythema‐multiforme‐artige (28 %), Sweet‐Syndrom‐artige (11 %) und pustulöse Läsionen (9 %). Bei allen Patienten wurden die Hautveränderungen von Fieber und Allgemeinsymptomen begleitet. Die meisten Patienten wurden oral mit Steroiden und Thalidomid therapiert. Dermatologen und Pathologen sollten die klinische Variabilität des ENL kennen, um Fehldiagnosen und verzögerte Behandlungen zu vermeiden. Die frühzeitige Erkennung kann die Kontrolle der Krankheitsprogression unterstützen und die Patienten vor weiteren Komplikationen schützen.

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Type 2 leprosy reaction resembling Sweet syndrome: Review of new and published cases

Cited by 10 publications

References 9 publications

Atypical presentations of erythema nodosum leprosum: Diagnostic and therapeutic aspects

Atypical presentations of erythema nodosum leprosum: Diagnostic and therapeutic aspects

New Practical Aspects of Sweet Syndrome

Atypisches Erythema nodosum leprosum: Diagnostische und therapeutische Aspekte

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