Haikal Samantha, Morgan Tyler, Patel Reeya, Gerstner Gary, Dann Rebecca Byler
University of Illinois College of Medicine Peoria, United States.
Illinois CancerCare, United States.
Gynecol Oncol Rep. 2022 Mar 14;40:100947. doi: 10.1016/j.gore.2022.100947. eCollection 2022 Apr.
Acute febrile neutrophilic dermatosis, or Sweet's Syndrome (SS), was first characterized by Dr. Robert Sweet in 1964 with eight cases of fever, neutrophilic polymorphonuclear leukocytosis, dermatological lesions, and histological evidence of dense dermal infiltration by mature neutrophils. SS presents in three settings: idiopathic, malignancy-associated, and drug-induced. In 1996, Walker and Cohen outlined the current diagnostic criteria for drug-induced SS with abrupt onset of painful lesions, dermal histology showing dense neutrophilic infiltrate, pyrexia > 38 °C, temporal relationship of drug administration to clinical presentation, and symptom resolution following drug withdrawal or systemic corticosteroid treatment. SS has rarely been reported in association with gynecologic malignancies.
Case Report.
A 41-year-old female receiving neoadjuvant chemotherapy for advanced high-grade serous ovarian carcinoma presented for evaluation of cyclic fevers with dermatologic lesions following treatment with Carboplatin and Taxol, with Pegfilgrastim. On days 11-17 of treatment she reported fevers ranging from 101°F-104°F (38 °C- 40 °C) with subsequent eruption of truncal erythematous, pustular, and painful coalescing plaques. Lesion biopsies confirmed histologic presence of dense neutrophilic infiltration. The patient was initiated on oral corticosteroid therapy with symptom improvement.
This case represents an example of SS in a patient receiving therapy with the most commonly implicated medication class, granulocyte colony-stimulating factor (GCSF). In drug-induced SS, there's often a temporal relationship between medication administration and symptom development. In this case, all criteria for drug-induced SS were met with a GCS-F as the likely causative agent. This case illustrates a rare diagnosis in the context of gynecologic cancer treatment and will expand available reports of SS in the Gynecologic Oncology literature. We hope to elicit more prompt recognition and diagnosis of SS from practitioners to minimize patient morbidity and long-term sequelae.
急性发热性嗜中性皮病，即斯威特综合征（SS），于1964年由罗伯特·斯威特博士首次描述，包括8例发热、嗜中性多形核白细胞增多、皮肤病变以及成熟嗜中性粒细胞密集真皮浸润的组织学证据。SS有三种表现形式：特发性、恶性肿瘤相关性和药物诱导性。1996年，沃克和科恩概述了药物诱导性SS的当前诊断标准，包括疼痛性病变突然发作、皮肤组织学显示嗜中性粒细胞密集浸润、发热>38°C、药物给药与临床表现的时间关系以及停药或全身使用皮质类固醇治疗后症状缓解。SS与妇科恶性肿瘤相关的报道很少。
病例报告。
一名41岁女性因晚期高级别浆液性卵巢癌接受新辅助化疗，在接受卡铂、紫杉醇和培非格司亭治疗后出现周期性发热并伴有皮肤病变前来评估。在治疗的第11 - 17天，她报告体温在101°F - 104°F（38°C - 40°C）之间，随后躯干出现红斑、脓疱和疼痛性融合斑块。病变活检证实组织学上存在密集嗜中性粒细胞浸润。患者开始接受口服皮质类固醇治疗，症状有所改善。
该病例代表了一名接受最常涉及的药物类别粒细胞集落刺激因子（GCSF）治疗的患者发生SS的例子。在药物诱导性SS中，药物给药与症状发展之间通常存在时间关系。在本病例中，满足了药物诱导性SS的所有标准，GCS - F可能是致病因素。该病例说明了妇科癌症治疗背景下的一种罕见诊断，并将扩展妇科肿瘤学文献中SS的现有报道。我们希望促使从业者更迅速地识别和诊断SS，以尽量减少患者的发病率和长期后遗症。
