Subcutaneous Sweet Syndrome With Vasculitis Features: Case Report and Review.

IF 1.1 4区 医学 Q4 DERMATOLOGY American Journal of Dermatopathology Pub Date : 2024-10-15 DOI:10.1097/DAD.0000000000002845
Jia Tang, Bing Lv
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Abstract

Background: Subcutaneous Sweet Syndrome (SSS) is a rare variant of Sweet Syndrome characterized by neutrophilic infiltration of subcutaneous adipose tissue without vasculitis. The presence of vasculitis in SSS is uncommon and poses diagnostic challenges.

Case presentation: A 38-year-old female presented with a one-year history of recurrent painful erythematous nodules on her limbs and face. Physical examination revealed asymmetrical erythematous patches and tender subcutaneous nodules with central necrotic eschars on the lower limbs. Laboratory tests were unremarkable except for a mildly elevated erythrocyte sedimentation rate. Histopathological analysis showed significant neutrophilic infiltration within the adipose lobules and vascular walls, along with extravasation of red blood cells, indicating vasculitis. The patient responded promptly to systemic corticosteroids; however, symptoms recurred upon tapering, necessitating ongoing steroid therapy.

Discussion: This case underscores the rare occurrence of vasculitis in SSS, expanding the histopathological spectrum of the disease. Literature review suggests that vasculitis in SSS may result from neutrophil-mediated vascular damage rather than immune complex deposition. The recurrent symptoms upon steroid tapering highlight the therapeutic challenges in managing SSS with vasculitis.

Conclusion: Recognition of vasculitis in SSS is crucial for accurate diagnosis and effective management. Further research is warranted to elucidate the pathogenesis and develop targeted treatment strategies for SSS with vasculitis.

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具有血管炎特征的皮下甜综合征:病例报告与回顾
背景:皮下斯威特综合征(SSS)是斯威特综合征的一种罕见变异型,其特点是皮下脂肪组织中性粒细胞浸润,但不伴有血管炎。SSS 中出现血管炎并不常见,给诊断带来了挑战:一名 38 岁的女性患者因四肢和面部反复出现疼痛性红斑结节已有一年病史。体格检查发现下肢有不对称的红斑和皮下触痛性结节,中央有坏死的痂皮。除红细胞沉降率轻度升高外,实验室检查无异常。组织病理学分析显示,脂肪小叶和血管壁内有明显的中性粒细胞浸润,并伴有红细胞外渗,这表明患者患有血管炎。患者对全身皮质类固醇治疗反应迅速,但症状在逐渐减轻后又复发,因此需要继续接受类固醇治疗:讨论:本病例强调了在 SSS 中发生血管炎的罕见性,扩大了该病的组织病理学范围。文献综述表明,SSS 中的血管炎可能是中性粒细胞介导的血管损伤所致,而非免疫复合物沉积。类固醇减量后症状复发,凸显了治疗伴有血管炎的 SSS 所面临的挑战:结论:识别 SSS 中的血管炎对于准确诊断和有效治疗至关重要。有必要开展进一步研究,以阐明其发病机制,并为伴有血管炎的 SSS 制定有针对性的治疗策略。
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来源期刊
CiteScore
1.80
自引率
9.10%
发文量
453
审稿时长
3 months
期刊介绍: The American Journal of Dermatopathology offers outstanding coverage of the latest diagnostic approaches and laboratory techniques, as well as insights into contemporary social, legal, and ethical concerns. Each issue features review articles on clinical, technical, and basic science advances and illuminating, detailed case reports. With the The American Journal of Dermatopathology you''ll be able to: -Incorporate step-by-step coverage of new or difficult-to-diagnose conditions from their earliest histopathologic signs to confirmatory immunohistochemical and molecular studies. -Apply the latest basic science findings and clinical approaches to your work right away. -Tap into the skills and expertise of your peers and colleagues the world over peer-reviewed original articles, "Extraordinary cases reports", coverage of practical guidelines, and graphic presentations. -Expand your horizons through the Journal''s idea-generating forum for debating controversial issues and learning from preeminent researchers and clinicians
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