Subcutaneous histiocytoid Sweet's syndrome in a patient with myelodysplastic syndrome and acute myeloblastic leukemia

Subcutaneous histiocytoid Sweet's syndrome is a rare variant of histiocytoid Sweet's syndrome (SS). We present a 68‐year‐old woman with subcutaneous histiocytoid SS in association with refractory myelodysplastic syndrome transformed to acute myeloblastic leukemia (AML), status post induction chemotherapy and with persistent blasts (50%) in the bone marrow and blood, accompanied with neutropenia. The patient presented to the emergency room with fever and altered mental status. Clinical examination revealed approximately 20 scattered 0.5–2 cm, pink to pink‐purple non‐tender firm nodules on the legs and left arm. The differential diagnosis included Sweet's syndrome (deep), leukemia cutis, infection, polyarteritis nodosa and erythema nodosum. Histopathologic examination of a biopsy from the left arm revealed a nodular infiltrate of neutrophils and histiocytoid mononuclear cells solely in the lobular compartment of the subcutaneous fat with focal areas of necrosis. Most cells in the infiltrate labeled with myeloperoxidase (MPO) including the histiocytoid cells. The cells were negative for CD34 and CD117. All special stains for microorganisms were negative. A diagnosis of subcutaneous histiocytoid SS was made. A subcutaneous histiocytoid SS should be suspected when a neutrophilic/histiocytoid panniculitis, occurring in the setting of myeloid disorders, is encountered and after exclusion of an infectious process and leukemia cutis.     

Sweet's syndrome associated with immunoblastic lymphadenopathy

Sweet's syndrome arose in a 54-year-old Japanese man who had suffered from general malaise, episodic fever, and lymphadenopathy for ten months. Skin symptoms subsided rapidly, but he died three months later with a postmortem diagnosis of immunoblastic lymphadenopathy.     

Sweet's syndrome with abscess-like lesions in a patient with acute myelogenous leukemia

We describe a 49-year-old man with acute myelogenous leukemia associated with Sweet's syndrome and abscess-like lesions mimicking an infectious disease. Although blisters may be included in the clinical spectrum, frank non-infectious abscesses have not been reported as far as we know. Clinicians should be familiar with this clinical and histopathologic variant of Sweet's syndrome. It is mandatory to make every effort to find an infectious cause for abscesses before a diagnosis of Sweet's syndrome is made.     

Primary tuberculosis cases presenting with erythema nodosum

Erythema nodosum (EN) is seen only in the primary tuberculosis (TB) form of tuberculous diseases. Among the etiologies of EN, TB is the most frequent disorder in developing countries. We aimed to assess our patients with EN in reference to primary TB. We evaluated 335 patients with the diagnosis of TB during last 20 years; retrospectively 61 (18%) of these cases had pulmonary and 274 (82%) had extrapulmonary TB. Ten (16%) of the pulmonary TB cases were primary. All 10 patients with primary TB presented with EN. Among 50 patients with EN diagnosed and followed during the last 10 years, the etiology was determined in 56%, and primary TB was the most frequent: 20%.     

Three cases of erythema nodosum associated with Yersinia enterocolitica infection

Three cases of erythema nodosum associated with Yersinia enterocolitica infection were reported. They were diagnosed as Yersinosis following isolation of Yersinia enterocolitica from the feces and from serological investigation. The diagnosis was supported by the fact that Yersinia enterocolitica could be separated from the feces at an early stage of infection and that the serum agglutination titer for Yersinia enterocolitica increased within a month of infection. Clinically, the erythema nodosum preceded by abdominal pain and/or diarrhea was a complication of Yersinosis.     

近25年结节性红斑患者中结核感染特点的Meta分析

目的：明确1993-2018年结节性红斑(EN)患者中结核(TB)感染特点。方法：2位研究者独立检索1993年1月至2018年9月PubMed、Embase、MEDLINE、CNKI、CBM、万方数据库筛选出符合纳入标准的文献，采用STATA 12.0软件通过Meta分析方法进行单个率的合并分析。结果：共纳入27篇文献，包括国内11篇（1019例患者，其中结核性结节性红斑患者277例，感染率25.4%），国外16篇（995例，其中结核性结节性红斑患者52例，感染率6%）。国内亚组分析显示东部、中部及西部地区EN患者中结核感染率分别为16.0%、27.9%和32.5%，Meta回归显示地区因素而非年份因素可解释异质性来源(P=0.02)。结节性红斑患者结核病灶为肺结核、淋巴结核、其他类型结核（如：结核性胸膜炎、卵巢结核等）、仅PPD强阳性，分别占44.4%、11.1%、7.1%及38.2%。结论：大多数EN患者没有明显的结核症状，因此应尽量寻找潜在的结核病感染病灶。     

A Case of Sweet's Panniculitis Associated with Spinal Metastasis from Prostate Cancer

Sweet''s panniculitis is a rare variant of Sweet''s syndrome in which neutrophilic infiltrate can be found either in the subcutaneous fat or in both the dermis and the subcutaneous tissue. Due to the rarity of this entity, the association between Sweet''s panniculitis and malignancies is inconclusive, but cases of Sweet''s panniculitis have largely been associated with hematological malignancies. Herein, we present a case of Sweet''s panniculitis accompanied by bone metastasis from prostate cancer. Clinicians should be aware that Sweet''s panniculitis may be associated with malignancies of solid organs.     

Pentoxifylline in the treatment of erythema nodosum leprosum

Erythema nodosum leprosum (ENL) is a well-known serious complication affecting 10% of lepromatous multibacillary leprosy patients. In the chronic form, its morbidity may be considerable. Thalidomide and systemic steroids are the two current effective drugs for the management of ENL. However, their use in endemic countries is often difficult and hazardous, and a search for new therapies is needed. We report our experience on the effects of pentoxifylline, a methylxanthine derivative, which has recently been suggested as a possible effective treatment for ENL attacks.     

Exploring the combination of SSKI and topical heparin in a case of erythema nodosum migrans

Erythema nodosum migrans (subacute nodular migratory panniculitis) is an uncommon type of panniculitis characterized by migrating subcutaneous nodules or plaque on the lower extremity. There are a very few cases of Erythema nodosum migrans reported and thus its appropriate treatment modality is not defined. We describe a case of a 30‐year‐old male with idiopathic erythema nodosum migrans which was manifest centrifugally spreading, slightly morpheaform erythematous plaque on the lower left leg. The patient was diagnosed initially and treated as a case of furunculosis with poor clinical response. The skin biopsy showed features consistent with subacute nodular panniculitis. Saturated Solution of Potassium Iodide along with topical Heparin successfully treated the patient, when the conventional treatment modalities failed. In a morpheaform centrifugally expanded plaque, erythema nodosum migrans should be kept in mind in the differential diagnosis, especially in the lower extremities in cases of unknown etiology.     

Sweet's Syndrome with Small Cell Carcinoma of the Lung

We report a 59-year-old male with Sweet's syndrome who developed small cell carcinoma of the lung one year after the initial diagnosis. To the best of our knowledge, this is the first report of Sweet's syndrome in conjunction with lung cancer. In cases of Sweet's syndrome, a search for not only hematologic disorders but also for solid tumors should be made.     

Tinea barbae associated with erythema nodosum in an immunocompetent man.

We describe the case of a 45-year-old man with atopy who developed marked inflammatory lesions on the bearded area of the face caused by Tricophyton rubrum, an anthropophilic fungus not frequently correlated with kerion of the face. After starting therapy with griseofulvin, he developed typical lesions of erythema nodosum on both legs. We discuss how these lesions could be correlated with the kerion of the face.     

Case of vemurafenib‐induced Sweet's syndrome

Vemurafenib is a targeted therapy that has become standard treatment for patients with advanced melanoma with a V600E BRAF mutation. It has been associated with frequent skin toxicity, including photosensitivity, rash and squamous cell carcinomas. We present an 83‐year‐old woman with an advanced V600E BRAF‐mutant melanoma who developed a severe skin rash and fatigue after taking vemurafenib. The dose was reduced from 960 to 720 to 480 mg twice a day; however, she was subsequently admitted to the hospital with fever, chills, fatigue, confusion and a diffuse skin eruption. She then developed hypoxia and acute renal failure that required hemodialysis. A biopsy of her skin lesions revealed a neutrophilic dermatitis with papillary dermal edema, consistent with Sweet's syndrome. Her symptoms resolved upon discontinuation of vemurafenib and treatment with prednisone. This constellation of symptoms and clinical course are consistent with drug‐induced Sweet's syndrome caused by vemurafenib.     

结节性红斑患者血清总IgE和MAO水平测定

目的：检测结节性红斑患者血清总IgE和单胺氧化酶（MAO）含量。方法：选择结节性红斑患者115例及正常人36名,应用化学发光免疫分析仪和全自动生化分析仪分别检测其血清总IgE和MAO。结果：结节性红斑患者血清总IgE含量235．36±295．14IU／mL高于健康对照组83．19±82．52IU／mL（P〈0．05）,血清MAO含量15．55±14．32U／L高于健康对照组7．43±3．76U／L（P〈0．01）。结论：IgE和MAO可能参与了结节性红斑的发病过程。     

A granulomatous conundrum: Concurrent necrobiosis lipoidica,cutaneous sarcoidosis and erythema nodosum in a nondiabetic patient

Necrobiosis lipoidica (NL) and cutaneous sarcoidosis are granulomatous disorders with a largely unknown aetiopathogenesis. Evidence of co‐existing NL and sarcoidosis in the same patient may suggest a degree of overlap between these entities through shared granulomatous inflammatory pathways. Occasionally, one condition can mimic the other, making their distinction difficult. We report a novel case of a non‐diabetic woman who presented with concurrent NL, cutaneous sarcoidosis and erythema nodosum. We discuss some of the complexities distinguishing these entities and propose that they may represent different stages of the same granulomatous process linked through yet unknown pathomechanisms.     

伴结节性红斑的大动脉炎2例临床及组织病理分析并文献复习

报告2例伴结节性红斑的大动脉炎。例1.患者女,43岁。例2.患者女,21岁。二例患者均因双下肢反复出现结节性红斑就诊,其中例2有间断发热。皮肤科检查：二例患者双下肢均可见散在结节性红斑。二例患者皮损组织病理检查均提示血管周围少许单核细胞或淋巴细胞浸润,皮下脂肪间隔增宽,胶原增生,部分脂肪细胞变性坏死,呈混合性脂膜炎改变。计算机断层摄影血管造影术（CTA）提示2例患者血管管腔均有不同程度的狭窄,例1患者狭窄部位位于头臂干、双侧颈动脉及锁骨下动脉,例2患者位于左锁骨下动脉。诊断：大动脉炎。     

Azathioprine‐induced Sweet's syndrome: A case series and review of the literature

We present three patients with azathioprine‐induced Sweet's syndrome (AISS) who attended our tertiary institution within a 12‐month period. Established associations exist between Sweet's syndrome and some medications; however, to date links to azathioprine are tentative. While there are case reports of AISS, most have occurred in patients with inflammatory bowel disease (IBD), an underlying predisposition for Sweet's syndrome. Our case series adds to the evidence that the entity of AISS truly exists independent of confounding factors such as concurrent IBD.