Pulmonary Manifestations of Systemic Disease: Systemic Disease |

Sweet’s Syndrome With Original Involvement of Lymph Node and Lung: A Case Report FREE TO VIEW

Yi Liang, MD; Ying Shen, MD; Jianquan Zhang, MD; Xiaoning Zhong, MD
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Guangxi Medical University, Nanning, China

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A466. doi:10.1016/j.chest.2016.02.485
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SESSION TITLE: Systemic Disease

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM

INTRODUCTION: Sweet’s syndrome (SS) is a dermatosis characterized by pyrexia, leukocytosis, tender erythematous skin lesions, a dense neutrophilic nfiltration on the dermis and various extra-cutaneous involvement. Furtherly, SS can be classified into three categories: classic or idiopathic, malignancy-associated, and drug-induced. That pulmonary symptoms and enlarged lymph nodes preceding typical skin lessions in class ic SS is rare and leads to misdiagnosis and wrong treatment due to lack of specific perception.

CASE PRESENTATION: A 38-year male of classic Sweet’s Syndrome initiated with enlarged lymph nodes and infiltrated pneumonia that progressed into respiratory failure, then 7 months later, typical skin lesions emerged. Lab test displayed peripheral leukocytosis with neutrophils and an elevated erythrocyte sedimentation rate. Pathological findings on lung, lymph node and skin were consistent, revealing a dense infiltration by mature neutrophils without leukocytoclastic vasculitis. The case was responsive well to corticosteroid but numb to antibiotics.

DISCUSSION: The onset of extra-cutaneous involvement preceding typical skin lesions, especially by over half year, is unusual in Class SS. Repeating application of corticosteroids outsides our hospital might have played a role in deferring onset of skin lesions. The enlarged lymph nodes with specific pathological findings in this patient suggests that lymph node can be a new site of extra-cutaneous manifestations of SS. The drastic evolution of the pulmonary invasion favored the possibility of pulmonary involvement of SS coexisting with bacterial pneumonia. The vulnerability to infection after intensive administration of immune-supressor and corticosteroid might have led to serious bacterial pneumonia in this case.

CONCLUSIONS: SS originating in extra-cutaneous organs instead of skin is rare. Clinical physicians should be alert to the possibility of SS when patients demonstrate leukocytosis and abnormally neutrophilic infiltrations in tissue, particularly in absence of infection or malignancy.

Reference #1: Rochet NM, Chavan RN, Cappel MA, Wada DA, Gibson LE. Sweet syndrome: clinical presentation, associations, and response to treatment in 77 patients. J AM ACAD DERMATOL 2013;69:557-564

Reference #2: Cohen PR. Sweet's syndrome—a comprehensive review of an acute febrile neutrophilic dermatosis. Orphanet J Rare Dis 2007;26:2:34

Reference #3: Fernandez-Bussy S, Labarca G, Cabello F, Cabello H, Folch E, Majid A. Sweet's syndrome with pulmonary involvement: Case report and literature review. Respir Med Case Rep 2012;17:16-19

DISCLOSURE: The following authors have nothing to disclose: Yi Liang, Ying Shen, Jianquan Zhang, Xiaoning Zhong

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