Ann Dermatol.  2009 Aug;21(3):300-303. 10.5021/ad.2009.21.3.300.

Localized Sweet's Syndrome in an Irradiated Field

• Lee GY
• Do MO
• Kim SH
• Choi HY
• Myung KB
• Choi YW

• KMID: 2266297
• DOI: http://doi.org/10.5021/ad.2009.21.3.300

Abstract

Sweet's syndrome is a reactive dermatosis characterized clinically by fever, leukocytosis, and multiple, erythematous, painful plaques. Histopathologic examination reveals a band-like dense dermal inflammatory infiltrate composed mainly of neutrophils with papillary dermal edema, and no features of vasculitis. We report a case of a 56-year-old female diagnosed with cervical cancer, who underwent surgery and concurrent chemoradiation therapy. Approximately 3 years after completing treatment, she presented with erythematous plaques, principally within the radiation field; the skin biopsy showed features consistent with Sweet's syndrome.

Keyword

Acute febrile neutrophilic dermatosis; Cervical carcinoma; Irradiation; Radiotherapy; Sweet's syndrome

MeSH Terms

Biopsy
Edema
Female
Fever
Humans
Leukocytosis
Middle Aged
Neutrophils
Skin
Skin Diseases
Sweet Syndrome
Uterine Cervical Neoplasms
Vasculitis

Figure

• 

  Fig. 1 (A) Well-demarcated erythematous and edematous plaques on the right flank and lower abdomen. (B) Multiple overlying vesicles on the erythematous plaques.

• 

  Fig. 2 (A) Edema of papillary dermis, and dense neutrophilic infiltration involving superficial and mid-dermis (H&E stain, ×100). (B) Dense neutrophilic infiltration, swelling of endothelial cells and dilatation of small blood vessels (H&E stain, ×400).

Reference

1. Cohen PR, Kurzrock R. Sweet's syndrome: a neutrophilic dermatosis classically associated with acute onset and fever. Clin Dermatol. 2000. 18:265–282.

2. van der Meij EH, Epstein JB, Hay J, Ho V, Lerner K. Sweet's syndrome in a patient with oral cancer associated with radiotherapy. Eur J Cancer B Oral Oncol. 1996. 32B:133–136.

3. Pertusi RM, Forman MD, Brown AC. Sweet's syndrome after splenic irradiation for chronic myelogenous leukemia. J Am Osteopath Assoc. 1996. 96:366–367.

4. Dawe SA, Phillips R, Porter W, Francis NA, Bunker CB. Sweet's syndrome as a complication of radiotherapy for squamous carcinoma of the pharynx. Br J Dermatol. 2003. 149:884.

5. Che Y, Tanioka M, Matsumura Y, Miyachi Y. Splenic irradiation-induced Sweet's syndrome associated with preceding myelofibrosis. Clin Exp Dermatol. 2008. 33:200–201.

6. Vergara G, Vargas-Machuca I, Pastor MA, Farina MC, Martin L, Requena L. Localization of Sweet's syndrome in radiation-induced locus minoris resistentae. J Am Acad Dermatol. 2003. 49:907–909.

7. Hymes SR, Strom EA, Fife C. Radiation dermatitis: clinical presentation, pathophysiology, and treatment 2006. J Am Acad Dermatol. 2006. 54:28–46.

8. Cohen PR, Talpaz M, Kurzrock R. Malignancy-associated Sweet's syndrome: review of the world literature. J Clin Oncol. 1988. 6:1887–1897.

9. Cohen PR, Holder WR, Tucker SB, Kono S, Kurzrock R. Sweet syndrome in patients with solid tumors. Cancer. 1993. 72:2723–2731.

10. Garcia-Rio I, Perez-Gala S, Aragues M, Fernandez-Herrera J, Fraga J, Garcia-Diez A. Sweet's syndrome on the area of postmastectomy lymphoedema. J Eur Acad Dermatol Venereol. 2006. 20:401–405.

11. Beesley V, Janda M, Eakin E, Obermair A, Battistutta D. Lymphedema after gynecological cancer treatment: prevalence, correlates, and supportive care needs. Cancer. 2007. 109:2607–2614.