[A case of Sweet syndrome in a patient receiving erlotinib for lung adenocarcinoma]. / Syndrome de Sweet chez une patiente traitée par erlotinib pour un adénocarcinome bronchique.

INTRODUCTION: Sweet syndrome is a neutrophilic dermatosis and is often idiopathic, although its onset may be drug-induced or paraneoplastic. The purpose of this case report is to describe the very first occurrence of Sweet syndrome following erlotinib intake in a patient diagnosed with lung adenocarcinoma. PATIENTS AND METHODS: We observed Sweet syndrome, as assessed by clinical, laboratory and histological examination, in a middle-aged female patient presenting lung adenocarcinoma diagnosed three years prior to her cutaneous symptoms. DISCUSSION: Given the extremely long time between the diagnosis of lung cancer and the onset of Sweet syndrome, as well as the occurrence of skin lesions during administration of the medication and their subsidence after drug withdrawal, we suggest a possible link between this particular EGFR tyrosine kinase inhibitor and the patient's neutrophilic dermatological signs. To our knowledge this association has not previously been described in the medical literature.

[Acute generalized pustular bacterid followed by Sweet's syndrome and erythema nodosum]. / Pustulose aiguë généralisée post-streptococcique suivie d'un syndrome de Sweet et d'un érythème noueux.

INTRODUCTION: Streptococcal infections can cause various skin manifestations related to the direct action of the offending organism itself or to a reactional mechanism. Reactional manifestations are less well known and understood, and they include generalized acute pustulosis belonging to the spectrum of neutrophilic dermatoses. We report a case of generalized acute pustulosis followed by Sweet syndrome and erythema nodosum occurring after a streptococcal infection. PATIENTS AND METHODS: A 60-year-old woman was consulting for a diffuse pustular rash after a throat infection, with high levels of anti-streptolysin (337 U/L) and anti-streptodornase (2560 U/L). The biopsy showed folliculitis and a neutrophilic infiltrator of the dermis, and bacteriological and mycological cultures were sterile. The patient then developed papules evoking Sweet syndrome followed by nodules typical of erythema nodosum after 20 days. A favourable outcome was achieved under colchicine. DISCUSSION: Generalized acute pustulosis is a form of neutrophilic dermatosis whose mechanisms, area predilection and treatment are poorly known. The clinical presentation of this patient was initially typical and the secondary progression to lesions like those in Sweet syndrome is consistent with the pathophysiological continuity and overlap of these entities.

[Chronic recurrent annular neutrophilic dermatosis]. / Dermatose neutrophilique annulaire récurrente chronique.

BACKGROUND: Chronic recurrent annular neutrophilic dermatosis (CRAND) is a rare form of neutrophilic dermatosis characterised by chronic annular progression, histological impairment similar to that seen in Sweet's syndrome and the absence of association with generalised signs, abnormal laboratory values or underlying systemic disease. Herein we report two new cases. PATIENTS AND METHODS: Case no 1. A 41-year-old woman had presented with four annular lesions on the forearms and neckline which she had had for one year. Examination revealed a 5-cm annular lesion on the right forearm and four similar adjacent lesions. The condition spontaneously resolved after 4 weeks. Treatment with hydroxychloroquine 400mg per day for three months proved ineffective in preventing a further episode. However, following treatment with colchicine at a daily dose of 1mg for two months, no further relapses in the rash occurred over a 10-year observation period. Case no 2. A 38-year-old woman consulted for recurrent annular erythema confined to the legs. Examination showed the presence of a red papular annular lesion on the right leg, encircling a yellowish macule with a central ring of fine scale; the lesion had been present for three weeks. Treatment with colchicine was initiated but the patient was lost to follow-up. In both cases, histological examination was evocative of Sweet's syndrome but no inflammatory or neutrophilic syndrome and no underlying systemic disease were demonstrated. DISCUSSION: CRAND presents as a stereotypical and benign form of neutrophilic dermatosis. A diagnosis of chronic recurrent annular dermatosis with gyrate progression should be considered in the absence of general signs, neutrophilia or underlying systemic disease.

Neutrophilic dermatoses.

Neutrophilic dermatoses (ND) are a group of inflammatory skin conditions characterized by a neutrophilic infiltrate on histopathology with no evidence of infection. ND are classified based upon the localization of neutrophils within the skin and clinical features. Recent findings suggest that ND are due to two main mechanisms: i) a polyclonal hereditary activation of the innate immune system (polygenic or monogenic); or ii) a clonal somatic activation of myeloid cells such as encountered in myelodysplastic syndrome or VEXAS syndrome. ND belong to internal medicine as a great number of patients with ND suffer from an underlying condition (such as hematological malignancy, inflammatory bowel disease, auto-immune and auto-inflammatory diseases). ND are diagnoses of exclusion and physicians should always consider differential diagnoses, particularly skin infections. Here, we review the pathophysiology and classification of the main ND (i.e., subcorneal pustular dermatosis (Sneddon-Wilkinson Disease) and Intercellular IgA dermatoses, aseptic pustulosis of the folds, Sweet syndrome, neutrophilic eccrine hidradenitis, pyoderma gangrenosum, erythema elevatum diutinum, neutrophilic urticarial dermatosis and neutrophilic panniculitis), their clinical and histopathological features, and we highlight the investigations that are useful to identify ND-associated diseases and to exclude the differential diagnoses.

[Drug-induced Sweet's syndrome related to hydroxychloroquine: About 2 cases]. / Syndrome de Sweet médicamenteux à l'hydroxychloroquine : à propos de 2cas.

INTRODUCTION: Hydroxychloroquine is widely prescribed in systemic lupus erythematosus. Dermatologic adverse drug reactions are rare but can mimic a disease specific manifestation of lupus. Exceptionally, Sweet's syndrome, or acute febrile neutrophilic dermatosis, may be drug-induced. CASE REPORTS: Two patients aged 31 and 42 years were treated with hydroxychloroquine for systemic lupus and Sjogren's syndrome, respectively. Three weeks after starting treatment, they had a febrile, purple and erythematous papular rash of the trunk and limbs. There was a biological inflammatory syndrome and skin biopsy disclosed an infiltrate of the dermis rich in neutrophils. Lesions regressed after stopping hydroxychloroquine and introducing systemic corticosteroid therapy. Allergologic tests discussed the differential diagnosis with a delayed-type hypersensitivity reaction. CONCLUSION: We report two exceptional cases of drug-induced Sweet's syndrome related to hydroxychloroquine treatment in autoimmune rheumatic diseases.

[Sweet's syndrome induced by pegfilgrastim during a myelodysplastic syndrome AREB2: A case report]. / Syndrome de Sweet induit par le pegfilgrastim au cours d'un syndrome myélodysplasique AREB2 : à propos d'un cas clinique.

INTRODUCTION: Sweet's syndrome is an acute neutrophilic dermatosis characterized by abrupt onset of skin lesions accompanied by fever, arthralgia, leukocytosis and diffuse neutrophilic infiltration of the dermis, as well as an excellent response to corticosteroid therapy. CASE REPORT: A 46-year-old patient with myelodysplastic syndrome was admitted for chemotherapy. On the eighth day of chemotherapy, he received a single dose of pegfilgrastim. Three days later, he developed pyrexia, conjunctivitis, arthralgia and erythematous and painful papulo-nodular lesions. Broad-spectrum empiric antibiotic therapy was started but the patient's condition deteriorated. Biology showed pancytopenia and inflammatory syndrome. Microbiological tests, autoimmune serologies and chest-computed tomography were negative. Cutaneous biopsy was compatible with Sweet's syndrome. A diagnosis of Sweet's syndrome induced by pegfilgrastim was made and intravenous corticosteroid therapy was started with a rapid favorable outcome. CONCLUSION: Sweet's syndrome is a rare adverse effect of G-CSF.

[Uncommon dermatologic disorders triggered by radiation therapy of breast cancer: A case-series]. / Dermatoses réactionnelles rares après radiothérapie : une série de cas avec cancer du sein.

Radiotherapy's main skin toxicities are now well-separated, acute (acute radiation dermatitis) or chronic complications (chronic radiation dermatitis, induced cutaneous carcinoma, aesthetic sequelae). Exceptionally, radiotherapy may induce, by isomorphic reaction or Koebner's phenomenon, some specific dermatosis. In this article, we report five new observations of these unusual complications of radiation therapy, occurring in very variable time after breast irradiation and remaining strictly localized in the irradiated field (cutaneous mastocytosis, Sweet syndrome, lichen planus, vitiligo). These cases emphasize the need to realize a systematic histological exam if any atypical skin lesion appears after radiotherapy, even long after.

[Neutrophilic dermatosis of the hands: acral sweet syndrome?]. / Dermatose neutrophilique des mains : un syndrome de Sweet acral ?

INTRODUCTION: Neutrophilic dermatosis may have various clinical presentations but share common histopathological manifestations with an aseptic infiltrate of polymorphonuclears neutrophils. Neutrophilic dermatosis of the hands is a recently described disorder of which we present a case. CASE REPORT: A 60-year-old woman, without significant past medical history, presented with an acute and painful eruption of both hands with fever. Clinical examination showed erythematous edematous lesions surmounted by pustules that covered the thenar eminences of both hands. The patient was also presenting inflammatory joint pain. Histological findings were predominantly neutrophilic infiltration in the dermis with leukocytoclastic debris. A diagnosis of neutrophilic dermatosis was made and all the lesions disappeared rapidly without relapse under oral prednisone (0.5mg/kg/j). CONCLUSION: The eruption observed in our patient was clinically and histologically suggestive of neutrophilic dermatosis of the hands, confirming the existence of a homogenous entity which is still debatable if it constitutes a separate entity or a localized variant of Sweet syndrome.

[Progressive cutaneous and pulmonary lesions without infectious etiology: two cases reports of sweet syndrome with pulmonary involvement]. / Lésions cutanées et infiltrats pulmonaires d'évolution défavorable sans cause infectieuse.

Sweet syndrome is a non infectious febrile disease with a neutrophilic infiltrate of dermis. Extracutaneous involvement can occur. We report two cases of Sweet syndrome with cutaneous and pulmonary involvement and give a short review of the literature of pulmonary involvement in Sweet syndrome.

Le syndrome de Sweet est une maladie fébrile se manifestant par un infiltrat neutrophilique important du derme, sans cause infectieuse. Une atteinte extra-cutanée n'est pas rare. Nous rapportons ici deux cas de syndrome de Sweet d'atteinte cutanée et pulmonaire et présentons une revue de la littérature sur les atteintes pulmonaires lors de syndrome de Sweet.