In 15-20% of cases, Sweet's syndrome (SS) develops secondary to cancer, the blood cancer, acute myeloid leukaemia (AML), being the commonest. Out of the total number of malignancy-associated cases, 85% have blood cancer.
This is a case of a 47-year-old woman who developed skin lesions that appeared on the third day after initiation of induction chemotherapy for AML. Skin biopsy suggested SS that was successfully treated with oral steroid medication.
- Induction chemotherapy with cytarabine and daunorubicin.
- Initially, non-itchy skin lesion on left forearm. Later, lesions developed on the neck and venipuncture sites (site of a vein where blood is taken). The latter was pathergy - skin lesions develop where the skin has been damaged. Lesions then became itchy and appeared on back.
- Fever of 39°C.
- Low white blood cell count, including neutrophil count. Normally high in SS, but more likely to be normal or low in patients with cancer/having chemotherapy.
- Elevated C-reactive protein indicating increased levels of inflammation in the body.
- SS can be drug-induced. Allopurinol, dipyrone, sulfamethoxazole and trimethoprim, cefepime, clindamycin and fluconazole were the main drugs used prior to the appearance of skin lesions. There seemed to be no connection between the appearance of the skin lesions and any of these drugs given during hospitalization.
- "The deletion of chromosome 5 or 5q and the presence of FLT3 mutations were the cytogenetic and molecular changes associated with a higher occurrence of SS (Kazmi et al, 2015)." However, "in a series of 13 Egyptian patients with AML and SS, cytogenetic alterations were documented in nine cases (El-Khalawany et al, 2017). None of these cytogenetic alterations found was more prevalent or associated with a higher occurrence of SS."
Spacek da Fonseca, G., Flávia Dinardi Alves Pinto, A., Cristina Fernandes Silveira, S., Henrique do Amaral e Silva, J., Afonso da Silva, V. and Rodrigues de Oliveira, L. (2020) Sweet's syndrome during induction chemotherapy for acute myeloid leukemia – case report and mini review. Hematology, Transfusion and Cell Therapy, Jul 20 (ScienceDirect). sciencedirect.com/science/a...