Piette W W, Trapp J F, O'Donnell M J, Argenyi Z, Talbot E A, Burns C P
Department of Dermatology, University of Iowa College of Medicine, Iowa City.
J Am Acad Dermatol. 1994 Feb;30(2 Pt 2):293-7. doi: 10.1016/s0190-9622(94)70026-5.
We report a case of leukemia-associated acute febrile neutrophilic dermatosis (Sweet's syndrome) that is unique because its initial histologic findings mimicked leukemia cutis. Otherwise, the clinical manifestations and response to corticosteroid therapy were typical of Sweet's syndrome. The onset of the dermatosis coincided with the onset of neutrophilic differentiation induced by single-agent leukemia therapy with all-trans-retinoic acid (ATRA). Subsequent exacerbation of the manifestations of Sweet's syndrome and the ultimate conversion of the histologic picture to the expected mature neutrophilic dermal infiltrate coincided with the completion of neutrophilic differentiation in the peripheral blood and bone marrow. The ability of immature neutrophil precursors to induce cutaneous lesions of Sweet's syndrome may indicate an ATRA-induced functional maturation that slightly precedes its effect on morphologic maturation. We conclude that a cutaneous infiltrate of early neutrophil precursors does not preclude a diagnosis of Sweet's syndrome in patients with acute leukemia who respond to ATRA therapy.
我们报告了一例与白血病相关的急性发热性嗜中性皮病（Sweet综合征），该病例很独特，因为其最初的组织学表现类似于皮肤白血病。否则，其临床表现及对皮质类固醇治疗的反应均为Sweet综合征的典型表现。皮肤病的发作与全反式维甲酸（ATRA）单药白血病治疗诱导的嗜中性分化发作同时出现。Sweet综合征表现的随后加重以及组织学图像最终转变为预期的成熟嗜中性真皮浸润与外周血和骨髓中嗜中性分化的完成同时发生。未成熟嗜中性前体细胞诱导Sweet综合征皮肤病变的能力可能表明ATRA诱导的功能成熟略先于其对形态成熟的影响。我们得出结论，在对ATRA治疗有反应的急性白血病患者中，早期嗜中性前体细胞的皮肤浸润并不排除Sweet综合征的诊断。
