Bortezomib‐Induced Sweet's Syndrome Confirmed by Rechallenge

Abstract

Sweet's syndrome, also known as acute febrile neutrophilic dermatosis, is characterized predominantly by fever, elevated neutrophil count, and erythematous skin lesions composed of plaques and nodules that appear on upper extremities, face, or neck. The incidence of Sweet's syndrome in the general population is unknown due to the rarity of the condition and potential lack of reporting. Bortezomib, an antineoplastic agent that is the standard of care in patients with multiple myeloma, has been reported to be associated with Sweet's syndrome. We describe a 69-year-old man who developed Sweet's syndrome during his initial course (after cycle 4) of bortezomib for treatment of multiple myeloma; he again experienced Sweet's syndrome 3.5 years later when rechallenged with bortezomib (after cycle 5) for treatment of relapsed multiple myeloma. The patient's signs, symptoms, and biopsy results were identical during both presentations of Sweet's syndrome. In both instances, the syndrome spontaneously resolved without incident and without supportive treatment with corticosteroids or antihistamines. To our knowledge, this is the first case report of a patient who developed Sweet's syndrome during an initial course of treatment with bortezomib and after rechallenge with bortezomib for relapsed disease. As proteasome inhibitors continue to be a mainstay of therapy for both treatment and salvage therapy for multiple myeloma, this case demonstrates that rechallenge with bortezomib is an option for patients who develop Sweet's syndrome.

Drug‐induced Sweet's syndrome: A case/non‐case study in the French pharmacovigilance database

“…Drug‐induced Sweet's syndrome with sulfamethoxazole‐trimethoprim 6,14 or G‐CSF 14,18–20 were the first published cases. Cases involving azathioprine, 7,21–23 bortezomib 7,24,25 and azacitidine 15,17,26,27 have also been widely published. Antineoplastics and antibacterials are the most represented therapeutic classes in the literature for drug‐induced Sweet's syndrome 12–14,28,29 ; this is in line with our results showing pharmacovigilance signals also for bendamustine, hydroxycarbamide and pristinamycin.…”

Symmetrical Intertriginous and Flexural Exanthema due to Bortezomib (a Proteasome Inhibitor) Given for Myeloma

“…A variety of skin reactions have been reported with bortezomib, either with the intravenous form (Sweet's syndrome (5), cutaneous lupus (6, 7), perivasculitis lymphocytic infiltrate with atypical CD30 (8)) or with the subcutaneous form (necrotic local reaction at the injection sites (9)) of this drug.…”

Neutrophilic dermatosis

“…]. Bortezomib-induced Sweet's syndrome has also been repeatedly observed and sometimes described as a histiocytoid form of Sweet's syndrome, in which the skin infiltrate consists of immature myeloid cells with a histiocytoid appearance [32,33]. Granulocyte colony-stimulating factor (GCSF) is considered one of the most common medications associated with Sweet's syndrome, also reported with pyoderma gangrenosum and neutrophilic panniculitis [29].…”

“…However, in the treatment of SPD, oral glucocorticoids tend to be less effective than dapsone as monotherapy. Disease control in few reported cases of bortezomib-induced Sweet's syndrome was achieved with administration of corticosteroids without cessation of the drug [32,33]. Intravenous pulse administration of methylprednisone sodium succinate may be used to treat patients with refractory disease [10 & ].…”