Rituximab for refractory subcutaneous Sweet's syndrome in chronic lymphocytic leukemia: A case report

Hashemi,Seyed Mehdi; Fazeli,Seyed Amirhossein; Vahedi,Abdolbaset; Golabchifard,Reza

doi:10.3892/mco.2015.715

Rituximab for refractory subcutaneous Sweet's syndrome in chronic lymphocytic leukemia: A case report

Authors:
- Seyed Mehdi Hashemi
- Seyed Amirhossein Fazeli
- Abdolbaset Vahedi
- Reza Golabchifard
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Affiliations: Division of Hematology and Medical Oncology, Department of Internal Medicine, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran, Department of Internal Medicine, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran , Students' Scientific Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
Published online on: December 18, 2015 https://doi.org/10.3892/mco.2015.715
Pages: 436-440

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Abstract

Sweet's syndrome is a neutrophilic dermatosis characterised by sudden onset of fever, neutrophilia, erythematous skin rashes and neutrophilic infiltration of the dermis. Subcutaneous Sweet's syndrome, or Sweet's panniculitis, is an uncommon variant of the classic syndrome, with hypodermal neutrophilic infiltration. The association of Sweet's syndrome with various malignancies has been reported. The most common underlying hematological malignancies are of myeloid origin; however, there have been several reports of the classic Sweet's syndrome in patients with a lymphoproliferative disorder, although the association of subcutaneous Sweet's syndrome with lymphoproliferative disorders has not been well‑documented thus far. Herein, we present the case of a 48‑year‑old man with a 2‑year history of chronic lymphocytic leukemia who developed fever and skin rashes, without any evidence of a relapse. The clinical and pathological investigation resulted in the diagnosis of subcutaneous Sweet's syndrome. The patient exhibited no significant response to conventional therapeutic measures; however, following two subsequent doses of rituximab, his general condition and skin rash improved. The follow‑up skin biopsy demonstrated dermal neutrophilic infiltrations in conjunction with prior mixed lobular and septal panniculitis, suggesting evolution of subcutaneous Sweet's syndrome to its classic form. To the best of our knowledge, this is one of the first reports of rituximab as a novel biological treatment for Sweet's syndrome. However, further randomized trials are required to evaluate the efficacy and safety of such biological therapies for Sweet's syndrome.

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1	Assari R, Ziaee V, Parvaneh N and Moradinejad MH: Periodic fever and neutrophilic dermatosis, Is it Sweet's syndrome? Case Reports Immunol. 2014:3209202014. View Article : Google Scholar : PubMed/NCBI
2	Prat L, Bouaziz JD, Wallach D, Vignon-Pennamen MD and Bagot M: Neutrophilic dermatoses as systemic diseases. Clin Dermatol. 32:376–388. 2014. View Article : Google Scholar : PubMed/NCBI
3	Thompson MA, Dyson SW and Faderl S: Sweet's syndrome in chronic lymphocytic leukemia associated with neutropenic fever and granulocyte colony-stimulation factor. Am J Hematol. 81:703–705. 2006. View Article : Google Scholar : PubMed/NCBI
4	Sweet RD: An acute febrile neutrophilic dermatosis. Br J Dermatol. 76:349–356. 1964. View Article : Google Scholar : PubMed/NCBI
5	Cohen PR: Sweet's syndrome - a comprehensive review of an acute febrile neutrophilic dermatosis. Orphanet J Rare Dis. 2:342007. View Article : Google Scholar : PubMed/NCBI
6	Dabade TS and Davis MD: Diagnosis and treatment of the neutrophilic dermatoses (pyoderma gangrenosum Sweet's syndrome). Dermatol Ther. 24:273–284. 2011. View Article : Google Scholar : PubMed/NCBI
7	Guhl G and Garcia-Diez A: Subcutaneous Sweet syndrome. Dermatol Clin. 26:541–551. 2008. View Article : Google Scholar : PubMed/NCBI
8	Bhandari PR and Pai VV: Novel applications of rituximab in dermatological disorders. Indian Dermatol Online J. 5:250–259. 2014. View Article : Google Scholar : PubMed/NCBI
9	Cullity J, Maguire B and Gebauer K: Sweet's panniculitis. Australas J Dermatol. 32:61–64. 1991. View Article : Google Scholar : PubMed/NCBI
10	Usul Afşar C, Paydaş S, Günaldi M, Bozkurt Duman B, Erçolak V, Zorludemir S and Açikalin A: Sweet syndrome in a patient with chronic lymphocytic leukemia/small lymphocytic lymphoma: Curious lymphocyte/neutrophil fluctuations. Turk J Haematol. 30:413–415. 2013. View Article : Google Scholar : PubMed/NCBI
11	Cholongitas E, Pipili C, Dasenaki M and Kaklamanis L: Piperacillin/tazobactam-induced Sweet syndrome in a patient with chronic lymphocytic leukemia and autoimmune cholangitis. Am J Dermatopathol. 30:203–204. 2008. View Article : Google Scholar : PubMed/NCBI
12	Tageja N, Giorgadze T and Zonder J: Dermatological complications following initiation of lenalidomide in a patient with chronic lymphocytic leukaemia. Intern Med J. 41:286–288. 2011. View Article : Google Scholar : PubMed/NCBI
13	Reuss-Borst MA, Müller CA and Waller HD: The possible role of G-CSF in the pathogenesis of Sweet's syndrome. Leuk Lymphoma. 15:261–264. 1994. View Article : Google Scholar : PubMed/NCBI
14	Cohen PR: Neutrophilic dermatoses: A review of current treatment options. Am J Clin Dermatol. 10:301–312. 2009. View Article : Google Scholar : PubMed/NCBI
15	Lipsker D, Perrigouard C, Foubert A and Cribier B: Anakinra for difficult-to-treat neutrophilic panniculitis, IL-1 blockade as a promising treatment option for neutrophil-mediated inflammatory skin disease. Dermatology. 220:264–267. 2010. View Article : Google Scholar : PubMed/NCBI
16	Kluger N, Gil-Bistes D, Guillot B and Bessis D: Efficacy of anti-interleukin-1 receptor antagonist anakinra (Kineret®) in a case of refractory Sweet's syndrome. Dermatology. 222:123–127. 2011. View Article : Google Scholar : PubMed/NCBI
17	Delluc A, Limal N, Puéchal X, Francès C, Piette JC and Cacoub P: Efficacy of anakinra, an IL1 receptor antagonist, in refractory Sweet syndrome. Anne Rheum Dis. 67:278–279. 2008. View Article : Google Scholar
18	Karamlou K and Gorn AH: Refractory Sweet syndrome with autoimmune organizing pneumonia treated with monoclonal antibodies to tumor necrosis factor. J Clin Rheumatol. 10:331–335. 2004. View Article : Google Scholar : PubMed/NCBI
19	Gill HH, Leung AY, Trendell-Smith NJ, Yeung CK and Liang R: Sweet syndrome due to myelodysplastic syndrome, Possible therapeutic role of intravenous immunoglobulin in addition to standard treatment. Adv Hematol. 2010:3283162010. View Article : Google Scholar : PubMed/NCBI
20	Haliasos E, Soder B, Rubenstein DS, Henderson W and Morrell DS: Pediatric Sweet syndrome and immunodeficiency successfully treated with intravenous immunoglobulin. Pediatr Dermatol. 22:530–535. 2005. View Article : Google Scholar : PubMed/NCBI
21	Lobo AM, Stacy R, Cestari D, Stone JH, Jakobiec FA and Sobrin L: Optic nerve involvement with panuveitis in Sweet syndrome. Ocul Immunol Inflamm. 19:167–170. 2011. View Article : Google Scholar : PubMed/NCBI
22	Schafranski MD, Merlini AB, Hungaro AC, Luciano JJ and Schumacher MS: Rituximab: Update on pharmacology and clinical applications.