Fujii Asami, Mizutani Yoko, Hattori Yuki, Takahashi Tomoko, Ohnishi Hidenori, Yoshida Shozo, Seishima Mariko
aDepartment of Dermatology, Gifu University Graduate School of Medicine, Gifu, Japan.
bDepartment of Pediatrics, Gifu University Graduate School of Medicine, Gifu, Japan.
Case Rep Dermatol. 2017 May 22;9(2):13-18. doi: 10.1159/000475878. eCollection 2017 May-Aug.
Sweet's syndrome is a neutrophilic dermatosis characterized by an abrupt onset of painful erythematous lesions showing neutrophilic infiltrates in the dermis. Fever and an elevated neutrophil level are generally observed. Sweet's syndrome may be idiopathic, malignancy-associated, or drug-induced (mainly involving granulocyte colony-stimulating factor (G-CSF) administration). Although systemic corticosteroids are usually effective, the symptoms of Sweet's syndrome recur in some refractory cases. Herein, we report a case of a 55-year-old Japanese woman with recurrent symptoms of fever (>39°C) and painful erythematous lesions on her four extremities, trunk, and neck. Laboratory findings revealed leukocytosis and high levels of C-reactive protein (CRP) and G-CSF. She was diagnosed with a recurrence of Sweet's syndrome, and was exclusively treated with granulocyte and monocyte adsorption apheresis (GMA) therapy once a week for 3 consecutive weeks. After the first session of GMA therapy, all symptoms including the erythematous lesions and fever were completely resolved, and serum G-CSF level was reduced. Leukocyte count, neutrophil count, serum amyloid A protein, and CRP levels were restored within normal ranges by 2 weeks. Thus, GMA therapy can successfully treat a patient with recurrent Sweet's syndrome, potentially related to the restoration of elevated serum G-CSF levels.
斯威特综合征是一种嗜中性皮病，其特征为突然出现疼痛性红斑病变，真皮层有嗜中性粒细胞浸润。通常会观察到发热和嗜中性粒细胞水平升高。斯威特综合征可能是特发性的、与恶性肿瘤相关的或药物诱导的（主要与使用粒细胞集落刺激因子（G-CSF）有关）。虽然全身用皮质类固醇通常有效，但在一些难治性病例中，斯威特综合征的症状会复发。在此，我们报告一例55岁日本女性病例，其四肢、躯干和颈部反复出现发热（>39°C）和疼痛性红斑病变症状。实验室检查结果显示白细胞增多以及C反应蛋白（CRP）和G-CSF水平升高。她被诊断为斯威特综合征复发，连续3周每周仅接受一次粒细胞和单核细胞吸附去除术（GMA）治疗。第一次GMA治疗后，包括红斑病变和发热在内的所有症状完全缓解，血清G-CSF水平降低。白细胞计数、嗜中性粒细胞计数、血清淀粉样蛋白A和CRP水平在2周内恢复到正常范围。因此，GMA治疗可成功治疗复发性斯威特综合征患者，这可能与血清G-CSF水平升高的恢复有关。
