Sweet's syndrome (SS) has been reported as an association with malignant neoplasms and autoimmune diseases, e.g., Behcet's disease, Sjogren's syndrome, and rheumatoid arthritis. But dermatomyositis (DM), one of the rare autoimmune diseases, was not reported as an associated disease of SS. We describe an interesting case of SS associated with DM. Diagnosis was made by skin biopsy, and subsequent clinical resolution occurred after institution of prednisolone.
Case Report ; Dermatomyositis/pathology ; Dermatomyositis/drug therapy ; Dermatomyositis/complications* ; Human ; Male ; Middle Age ; Prednisolone/therapeutic use ; Sweet's Syndrome/pathology ; Sweet's Syndrome/drug therapy ; Sweet's Syndrome/complications*

We present two cases of acute febrile neutrophilic dermatosis developed in women aged 56 and 52. One of the two patients deveIoped the lesions during longterm antituberculosis chemotherapy for her advanced pulmonary tuberculosis, The other case developed the lesions, initially at the site of acupuncture done for relief of her arthralgia, followed by the involvement of the other sites. The etiology of acute febrile neutrophilic dermatosis is not clear, however, hypersensitivity and association with systemic diseases such as upper respiratory infection, malignancies, ulcerative colitis and pyoderma gangrenosum are postulated.
Acupuncture ; Arthralgia ; Colitis, Ulcerative ; Drug Therapy ; Female ; Humans ; Hypersensitivity ; Pyoderma Gangrenosum ; Sweet Syndrome* ; Tuberculosis, Pulmonary

OBJECTIVETo identify the side effect of all-trans retinoic acid (ATRA), and improve early therapeutic response in patients with acute promyelocytic leukemia (APL).

METHODThe first case of Sweet's syndrome (SS) developed in a APL patient treated with ATRA was reported in mainland of China, and reviewed correlative literature.

RESULTSOnly 14 cases of SS associated with ATRA therapy in APL have been reported in the literature, including the present case. The median age was 49.5 years (9 -84) and 10 were women and 4 men. Of them, SS was restricted to the skin in 10 case, the other 4 muscle, fascia, kidney, and lung were involved. SS appeared after a median of 18 days of ATRA therapy (6 - 34 days). The median WBC count was 7.05 (0.80 - 23.00) x 10(9)/L. Four patients continued with the ATRA therapy without interruption, 13 patients treated with steroids and 12 responded. One patient improved without any treatment. Two cases of SS developed retinoic acid syndromes after ATRA therapy.

CONCLUSIONSweet's syndrome is a rare adverse effect of ATRA, and has similar features with inflammatory or infective dermatosis. The corticosteroids treatment could improve the systemic and cutaneous symptoms. When ATRA therapy was restarted after SS subsided, no recurrence of rashes was observed.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Female ; Humans ; Leukemia, Promyelocytic, Acute ; drug therapy ; Male ; Middle Aged ; Sweet Syndrome ; chemically induced ; Tretinoin ; adverse effects ; therapeutic use

All-trans retinoic acid (ATRA) is the standard induction treatment for acute promyelocytic leukemia (APL). Quite many ATRA-related side effects, including retinoic acid syndrome, were reported. So far, it has rarely been reported that Sweet's syndrome, characterized by fever, neutrophilia, painful erythematous cutaneous plaques, dense dermal infiltrates of mature neutrophils and rapid response to steroid therapy, is associated with ATRA. In the case that Sweet's syndrome associated with ATRA is found, physicians will have to face a great challenge over the possibility of infectious conditions. We present here a case of Sweet's syndrome associated with ATRA. A 35-year-old female with APL developed fever, painful erythematous cutaneous plaques on both cheeks, right wrist and both shins during induction chemotherapy with ATRA. A skin biopsy revealed a dense dermal infiltrate, consisting of mature neutrophils without vasculitis or cutaneous immunoglobulin deposits, which is compatible with Sweet's syndrome. Oral prednisone was administered and the lesions started to improve within 48 hours
Adult ; Biopsy, Needle ; Case Report ; Female ; Follow-Up Studies ; Human ; Leukemia, Promyelocytic, Acute/diagnosis/*drug therapy ; Prednisone/administration & dosage ; Risk Assessment ; Sweet's Syndrome/*chemically induced/drug therapy/*pathology ; Tretinoin/*adverse effects/therapeutic use

Mycobacteruim kansasii occasionally causes disseminated infection with poor outcome in immunocompromised patients. We report the first case of disseminated M. kansasii infection associated with multiple skin lesions in a 48-yr-old male with myelodysplastic syndrome. The patient continuously had taken glucocorticoid during 21 months and had multiple skin lesions developed before 9 months without complete resolution until admission. Skin and mediastinoscopic paratracheal lymph node (LN) biopsies showed necrotizing granuloma with many acid-fast bacilli. M. kansasii was cultured from skin, sputum, and paratracheal LNs. The patient had been treated successfully with isoniazid, rifampin, ethmabutol, and clarithromycin, but died due to small bowel obstruction. Our case emphasizes that chronic skin lesions can lead to severe, disseminated M. kansasii infection in an immunocompromised patient. All available cases of disseminated M. kansasii infection in non HIV-infected patients reported since 1953 are comprehensively reviewed.
Antitubercular Agents/therapeutic use ; Clarithromycin/therapeutic use ; Glucocorticoids/therapeutic use ; Humans ; Immunocompromised Host ; Isoniazid/therapeutic use ; Male ; Middle Aged ; Mycobacterium Infections, Nontuberculous/*diagnosis/drug therapy/immunology ; *Mycobacterium kansasii/isolation & purification ; Myelodysplastic Syndromes/drug therapy ; Rifampin/therapeutic use ; Skin Diseases, Bacterial/*diagnosis/immunology/pathology ; Sputum/microbiology ; Sweet Syndrome/diagnosis