Sweet`s syndrome during the treatment of acute promyelocytic leukemia with all - trans retinoic acid

Abstract

All-trans retinoic acid (ATRA) is the standard induction treatment for acute promyelocytic leukemia (APL). Quite many ATRA-related side effects, including retinoic acid syndrome, were reported. So far, it has rarely been reported that Sweet’s syndrome, characterized by fever, neutrophilia, painful erythematous cutaneous plaques, dense dermal infiltrates of mature neutrophils and rapid response to steroid therapy, is associated with ATRA. In the case that Sweet’s syndrome associated with ATRA is found, physicians will have to face a great challenge over the possibility of infectious conditions. We present here a case of Sweet’s syndrome associated with ATRA. A 35-year-old female with APL developed fever, painful erythematous cutaneous plaques on both cheeks, right wrist and both shins during induction chemotherapy with ATRA. A skin biopsy revealed a dense dermal infiltrate, consisting of mature neutrophils without vasculitis or cutaneous immunoglobulin deposits, which is compatible with Sweet’s syndrome. Oral prednisone was administered and the lesions started to improve within 48 hours.

Sweet's syndrome – a comprehensive review of an acute febrile neutrophilic dermatosis

“…Since most patients with classic Sweet's syndrome have a febrile upper respiratory tract infection or tonsillitis that precedes their skin lesions by 1 to 3 weeks, a bacterial infection may have a causative role. Also, the manifestations of Sweet's syndrome improve with systemic antibiotics in some of the patients with dermatosis-associated culture-confirmed and serology-confirmed Yersinia enterolitica intestinal infection [2,77,125-127]. …”

Differentiation Syndrome with Severe Abdominal Pain During Induction Treatment of Acute Promyelocytic Leukemia: A Case Report

“…Based on these pathophysiologic mechanisms, APL DS presents in diverse and nonspecific symptoms, which make the diagnosis of DS challenging. In addition to the most common signs, rare symptoms such as diffuse alveolar hemorrhage, 7 Sweet’s syndrome 8 and ocular manifestations 9 have also been reported. It is necessary to identify DS when patients present with rare symptoms.…”

Fluorescence in situ hybridization investigation of cutaneous lesions in acute promyelocytic leukemia

“…Sweet's syndrome, an acute febrile neutrophilic dermatosis, has been reported in patients with acute promyelocytic leukemia after ATRA therapy and is characterized by fever, neutrophilia, painful ulcer-like plaques, and rapid response to steroid therapy. [19][20][21][22][23][24][25][26][27][28][29] This is often linked to or followed by the retinoic acid syndrome, a distinct clinical syndrome reported in up to one-quarter of patients treated with ATRA characterized by fever, dyspnea, hypotension, pleural or pericardial effusions and weight gain. 30 ATRA-associated genital ulcerations, [11][12][13][14][15][16][17][18] and ATRA-associated vasculitis 31 and myositis 32 have also been described in patients with acute promyelocytic leukemia.…”