A Case of Sweeps Syndrome with Rjlmonary Manifestation: DISCUSSION

Sweet syndrome may occur in the absence of other diseases as an idiopathic form, but is often associated with various diseases including malig­nancy, and mav be induced by several medications or pregnancy. Associated diseases are variable; cancers including both hematologic malignancies and solid tumors, infections involving the upper respiratory tract and gastrointestinal tract, inflamma­tory diseases such as Behcet disease, erythema nodosum, rheumatoid arthritis and sarcoidosis, and thyroid disease.

Tender, erythematous plaques characterize typical cutaneous lesions. Occasionally, the surface of the plaques may develop vesiculation or pustulation as a result of an intense dermal inflammatory infiltrate and accompanying dermal edema. This feature is more common in Sweet syndrome associated with hematologic malignancy. Our case also showed superimposed, multiple vesicles and pustules in some lesions. Frequently, Sweet syndrome may exhibit systemic symptoms such as fever, headache, arthra­lgia, myalgia, conjunctivitis and episcleritis.
To date, no specific pathogenesis has been found. It is postulated to be a form of a hypersensitivity reaction to a bacterial, viral, or tumor antigen. As a result of the hypersensitivity response, an inappro­priate endogenous cytokine such as granulocyte- macrophage colony-stimulating factor (GM-CSF), interleukin-1 /3 (IL-1/3), and interferon-T (IFN-Y) are released and these may lead to subsequent neutrophilic activations. buy levitra 20 mg

Rarely, Sweet syndrome may involve the internal organs such as the lungs, heart, kidney, liver, intes­tine and pancreas. Also neurologic and musculos­keletal involvements have been described. A cough, dyspnea, or pleurisy may represent pulmonary involvement, and pulmonary infiltration and effusion in Sweet syndrome may be seen upon chest X-ray evaluation. The most common causes of lung infil­tration are underlying infections and neoplasms, but the occurrence of noninfectious and nonneoplastic lung infiltration may rarely exist. On the open lung biopsies, the histologic changes were similar to those changes noted in the skin lesion. These lung lesions can be improved and resolved during systemic corticosteroid therapy.

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