Can vaccination trigger Sweet’s syndrome?

Sweet’s syndrome triggered by vaccination.

There is some medical evidence to show that certain vaccinations can potentially trigger Sweet’s syndrome, but this is incredibly rare, and it is important to take the following information into consideration:

  • Sweet’s syndrome is rare, probably affecting no more than 3 people per 10,000 (Zamanian and Ameri, 2007).
  • It mainly affects adults not children, and only 5% to 8% of cases have been in children (Sharma et al, 2015).
  • In some people, something is needed to trigger the onset of Sweet’s syndrome, but in up to 71% of people with Sweet’s syndrome there is no known trigger (Tam and Ingraffea, 2015).
  • Infection is a more common trigger for Sweet’s syndrome than vaccination, and as a result, Sweet’s syndrome tends to be more common in countries where people are more likely to develop infections (Ginarte and Toribio, 2011: 120). It is most commonly triggered by upper respiratory tract infection, but can be triggered by other infections too.
  • There have only been 10 cases of Sweet’s syndrome triggered by vaccination reported in medical literature in the past 42 years – globally! In some of these cases, a definite connection between the vaccination and Sweet’s syndrome was not established.
  • Sweet’s syndrome has only been associated with certain vaccinations and not others (see below).

Which vaccinations have been associated with Sweet’s syndrome?

Sweet’s syndrome has been associated with the following vaccinations:

  • Bacillus Calmette-Guerin (BCG or tuberculosis) (Carpentier et al, 2002: 82; Cruz-Velasquez et al, 2016). Two cases. One in 1986, occurring 15 days after vaccination, but the authors of the medical article that reported this did not control the tuberculin (Mantoux) test. One reported in 2002, occurring 10 days after vaccination.
  • Streptococcus pneumonia (Carpentier et al, 2002: 82; Cruz-Velasquez et al, 2016; Pedrosa et al, 2013). Two cases. One reported in 1990, occurring 4 days after vaccination following a splenectomy. One reported in 2013, and the first with the 13-valent conjugate vaccine.
  • Smallpox (Carpentier et al, 2002: 82; Cruz-Velasquez et al, 2016). Two cases reported in 1975, occurring 3 days after vaccination.
  • Influenza (Cruz-Velasquez et al, 2016; Hali et al, 2010, Jovanovic et al, 2005; Tan el al. 2006; Wolf et al. 2009). Four cases. One reported in 2005; in 2006, one case of bullous Sweet’s syndrome following vaccination in a HIV-infected patient; in 2009, neutrophilic dermatosis of the hands occurring 12 hours after vaccination; in 2010, one case of Sweet’s syndrome after H1N1 influenza (swine fluvaccination.

Do vaccinations trigger Sweet’s syndrome because they are toxic or contain dangerous chemicals?

No. Vaccinations do not trigger Sweet’s syndrome because they are toxic or contain dangerous chemicals, and anyone who tells you this is either lying to you, trying to scare you, or has no understanding of vaccinations and Sweet’s syndrome.

Why do vaccinations trigger Sweet’s syndrome?

Vaccination can trigger Sweet’s syndrome because of hypersensitivity reaction. This is not the same as allergic reaction.

What is hypersensitivity reaction?

Sweet’s syndrome is caused by errors in the innate immune system  the body’s most primitive, ‘hard-wired’ immune system, and a part of the immune system that doesn’t produce antibodies. Because of these errors, in some people with Sweet’s syndrome, their innate immune system responds to antigens – mainly proteins or sugars on the surface of a cell, or a non-living substance that a part of your immune system called the adaptive immune system sees as a foreign invader and produces antibodies in response to – in a way that it shouldn’t, i.e. is hypersensitive and goes into overdrive, overreacting to the presence of infectious, inflammatory, drug, or tumour cell antigens (Bhat et al, 2015: 257; Kasirye et al, 2011: 135). This means that the presence of antigens associated with certain health conditions, medications and vaccinations can potentially trigger Sweet’s syndrome by causing the innate immune system to unnecessarily activate or activate too many inflammatory cells, mainly white blood cells called neutrophils (Gosheger et al, 2002: 70). This then leads to the symptoms of Sweet’s syndrome.

If I have Sweet’s syndrome should I avoid having vaccinations?

No. Most people with Sweet’s syndrome don’t need to avoid having their vaccinations unless they can’t be vaccinated for other medical reasons, e.g. they are taking certain types of medication or have other health conditions. However, if the Sweet’s syndrome was initially triggered by a particular vaccination, e.g. influenza, then it would not be advisable to have the same kind of vaccination again.

How do I know if vaccination has triggered my Sweet’s syndrome?

Remember, Sweet’s syndrome triggered by vaccination is incredibly rare, but if it does happen, then symptoms usually develop within hours, days or less commonly, a few weeks after vaccination. Skin lesions sometimes appear at the vaccination site, but this can also happen because of the skin damage caused by having the vaccination (puncture wound from the needle) rather than the vaccine itself. This response is known as pathergy.

Are there other triggers for Sweet’s syndrome?

Yes, and aside from the triggers that have already been mentioned (infection, skin damage, and vaccination), other triggers for Sweet’s syndrome include:

  • Cancer and blood disorders in 15-20% of cases, e.g. solid tumours, and myelodysplastic syndrome which may progress to acute myeloid leukaemia (Chen et al, 2016).
  • Inflammatory bowel disease, e.g. Crohn’s disease and ulcerative colitis (Cohen, 2007).
  • Autoimmune conditions, e.g. rheumatoid arthritis and systemic lupus erythematosus.
  • Medications in up to 5% of cases.
  • Pregnancy in up to 2% of cases. This is probably associated with hormonal changes, but further research is required.
  • Overexposure to sunlight or ultraviolet (UV) light. This can sometimes trigger Sweet’s syndrome, but we are not entirely sure why this happens.

References.

Bhat, Y., Hassan, I., Sajad, P., Akhtar, S. and Sheikh, S. (2015) Sweet’s Syndrome: An Evidence-Based Report. Journal of the College of Physicians and Surgeons – Pakistan, Jul;25(7):525-7 (PubMed).

Carpentier, O., Piette, F. and Delaporte, E. (2002) Sweet’s syndrome after BCG vaccination. Acta Dermato-Venereologica;82(3):221 (PubMed).

Chen, S., Kuo, Y., Liu, Y., Chen, B., Lu, Y. and Miser, J. (2016) Acute Myeloid Leukemia Presenting with Sweet Syndrome: A Case Report and Review of the Literature. Pediatrics and Neonatology (online).

Cohen, P. (2007) Sweet’s syndrome – a comprehensive review of an acute febrile neutrophilic dermatosis (online).

Cruz-Velásquez, G., Pac Sha, J., Simal Gil, E. and Gazulla, J. (2016). Aseptic meningitis and anti-β2-glycoprotein 1 antibodies in Sweet syndrome. Neurologia (Barcelona, Spain), Jul 21 (0nline). Article in Spanish, use translate

Ginarte, M. and Toribio, J. (2011) Sweet Syndrome. In Dr. Fang-Ping (Ed.) Autoimmune Disorders – Current Concepts and Advances from Bedside to Mechanistic Insights. Croatia or China: Intech, pp. 119-132 (PDF). 

Gosheger, G., Hillman, A., Ozaki, T., Buerger, H. and Winklemann, W. (2002) Sweet’s Syndrome Associated With Pigmented Villonodular Synovitis. Acta Orthopædica Belgica, Feb;68(1):68-71 (PubMed).

Hali, F., Sbai, M., Benchikhi, H., Ouakadi, A. and Zamiati, S. (2010) [Sweet’s syndrome after H1N1 influenza vaccination]. Annales de Dermatologie et de Venereologie,  Nov;137(11):740-1 (PubMed).

Jovanovic, M., Poljacki, M., Vujanovic, L. and Duran, V. (2005) Acute febrile neutrophilic dermatosis (Sweet’s syndrome) after influenza vaccination. Journal of the American Academy of Dermatology, Feb;52(2):367-9 (PubMed).

Kasirye, Y., Danhof, R., Epperla, N. and Garcia-Montilla, R. (2011) Sweet’s Syndrome: One Disease, Multiple Faces. Clinical Medicine & Research, Nov;9(3-4):134-136 (online).

Pedrosa, A., Morais, P., Nogueira, A., Pardal, J. and Azevedo, F. (2013) Sweet’s syndrome triggered by pneumococcal vaccination. Cutaneous and Ocular Toxicology, Sep;32(3):260-1 (PubMed).

Sharma, A., Rattan, R., Shankar, V., Tegta, G. and Verma, G. (2015) Sweet’s syndrome in a 1-year-old child. Indian Journal of  Paediatric Dermatology;16:29-31 (online).

Tam, C. and Ingraffea, A. (2015) Case Letter: Sweet Syndrome Presenting With an Unusual Morphology. Cutis, Aug;96(2):E9-E10 (online).

Tan, A., Tan. H., and Lim, P. (2006) Bullous Sweet’s syndrome following influenza vaccination in a HIV-infected patient. International Journal of Dermatology, Oct;45(10):1254-5 (PubMed). 

Zamanian, A. and Ameri, A. (2007) Acute febrile neutrophilic dermatosis (Sweet’s syndrome): a study of 15 cases in Iran. International Journal of Dermatology, Jun;46(6):571-4 (PubMed).

Wolf, R., Barzilai, A. and Davidovici, B. (2009) Neutrophilic dermatosis of the hands after influenza vaccination. International Journal of Dermatology, Jan;48(1):66-8 (PubMed).

© 2012-2017 Sweet’s Syndrome UK

Herbs and supplements that should be avoided or used with caution in Sweet’s syndrome

Reposted and updated 29/06/16.

Alternative therapists are recommending or using certain herbs and supplements to treat or cure Sweet’s syndrome, despite the fact that there is no medical evidence that any of these treatments work, and some may not be safe to use.

A list of some herbs and supplements that have been recommended or used by alternative therapists to treat Sweet’s syndrome.

Alfalfa – flowering plant.

There is no evidence to show that alfalfa is helpful in the treatment of Sweet’s syndrome. May not always to be safe to use.

Best avoided or used with caution if:

  • You have an autoimmune condition, particularly systemic lupus erythematosus (SLE), as it may increase the risk of a flare-up (see ‘Additional notes’). Also, be aware of the fact that alfalfa can sometimes cause symptoms that are similar to SLE.
  • You have an autoinflammatory condition such as Sweet’s syndrome, particularly if it has developed secondary to an autoimmune condition (see ‘Additional notes’).
  • You have diabetes as it may lower blood sugar levels.
  • You are taking medications that increase sensitivity to sunlight. For example, dapsone, and tetracycline antibiotics such as doxycycline and minocycline.

DO NOT use if:

  • You have a hormone sensitive condition, e.g. breast cancer or endometriosis, as alfalfa can make these conditions worse.
  • You have had a kidney transplant as it may lead to rejection.
  • You are taking any of these medications: immunosuppressants, e.g. prednisone (see ‘Additional notes), or warfarin, contraceptives, or oestrogens.

Astragalus – flowering plant.

There is no evidence to show that astragalus is helpful in the treatment of Sweet’s syndrome. May not always to be safe to use.

Best avoided or used with caution if:

  • You have an autoimmune condition.
  • You have an autoinflammatory condition, particularly if it has developed secondary to an autoimmune condition.

DO NOT use if:

  • You are taking these medications: immunosuppressants, or lithium.
  • You are pregnant or breast-feeding.

Chlorella – algae.

There is no evidence to show that chlorella is helpful in the treatment of Sweet’s syndrome. May not always to be safe to use. Read more here.


Echinacea – herbaceous flowering plant.

There is no evidence to show that echinacea is helpful in the treatment of Sweet’s syndrome. May not always to be safe to use.

Best avoided or used with caution if:

  • You have an autoimmune condition.
  • You have an autoinflammatory condition, particularly if it has developed secondary to an autoimmune condition.
  • You are taking the medication midazolam.
  • You drink caffeinated drinks. Echinacea decreases how quickly caffeine is broken down, and this leads to increased levels in the bloodstream.

DO NOT use if:

  • You are taking immunosuppressants .
  • You are taking any of these medications as echinacea can affect how they are broken down: clarithromycin, clozapine, cyclobenzaprine, cyclosporine, diltiazem, fluvoxamine, haloperidol, imipramine, indinavir, lovastatin, mexiletine, oestrogens, olanzapine, pentazocine, propranolol, tacrine, theophylline, triazolam, zileuton, zolmitriptan, and possibly others (check with your doctor).
  • You are prone to allergies, particularly if you have an allergy to ragweed pollen, chrysanthemums, marigolds, or daisies.
  • You are pregnant or breast-feeding.

Red root – herbaceous flowering plant.

There is no evidence to show that red root is helpful in the treatment of Sweet’s syndrome. May not always to be safe to use.

Dosage:

  • The appropriate dose of red root would depend on factors such as age, medication, and health conditions, but at this time, there is not enough medical evidence to determine an appropriate range of doses.

When taken by mouth, short-term side-effects include:

  • Nausea.
  • Vomiting.
  • Drowsiness, or grogginess.

Other short-term problems:

  • Skin contact with the fresh plant may cause a rash.
  • If it gets into your eyes it can cause irritation.

When taken by mouth and in high amounts (see ‘Dosage’), long-term side-effects include:

  • Increased risk of  developing white patches on the inside of the mouth if used as a toothpaste or a mouthwash.
  • Glaucoma.
  • Low blood pressure.
  • Shock.
  • Coma.

Red root is a debriding agent, i.e. removes skin tissue. DO NOT apply to the skin if:

  • You have Sweet’s syndrome, or any other condition that is associated with pathergy. This may trigger the development of skin lesions or make existing lesions worse.

Red root is an irritant. DO NOT use if:

  • You have any condition affecting the gastrointestinal tract, including an infection, inflammatory bowel disease, or an inflamed bowel caused by Sweet’s syndrome.

Also, DO NOT use if:

  • You have glaucoma.
  • Are pregnant or breastfeeding.
  • You are taking any medications. There is a lack of information relating to how red root may interact with medications, so it may not be safe to use. In fact, some of these interactions may be dangerous.

Zinc (oral) – a mineral.

There is no evidence to show that zinc is of any use in the treatment of Sweet’s syndrome. May not always to be safe to use.

Dosage:

  • Safest zinc dosage is 40mg daily or less.
  • Taking more than 100 mg of supplemental zinc daily or taking supplemental zinc for 10 or more years doubles the risk of developing prostate cancer.
  • Single doses of 10-30 grams (10,000-30,000 mg) of zinc can be fatal.

Best avoided or used with caution if:

  • You have diabetes as zinc may lower blood sugar levels.
  • You are pregnant or breastfeeding (high doses).

DO NOT use if:

  • You are taking tetracycline antibiotics. Zinc prevents them from being absorbed properly.
  • You are taking any of these medications: amiloride, cisplatin, penicillamine, quinolone antibiotics, e.g. ciprofloxacin.

Additional notes.

Why should some of the herbs and supplements listed above be avoided or used with caution in those with autoimmune or autoinflammatory conditions?

Autoimmune and autoinflammatory conditions are caused by an overactive and not an underactive immune system – an overactive adaptive immune system in autoimmune conditions and an overactive innate immune system in autoinflammatory conditions. Some herbs and supplements have been proven to ‘boost’ the immune system. This means that they can increase immune system activity or make it more active. In patients with autoimmune conditions, this has the potential to make their overactive immune systems even more overactive, making symptoms worse. Evidence is needed before we know if these same herbs and supplements can negatively affect autoinflammatory conditions such as Sweet’s syndrome, but as yet, no research has been conducted. However, it is important to remember that Sweet’s syndrome can develop secondary to autoimmune conditions, and if this is the case, when the autoimmune condition flares-up the Sweet’s syndrome often does too.

Why should some of the herbs and supplements listed above be avoided if you are taking immunosuppressants?

Immunosuppressants are medications that suppress or ‘dampen down’ the immune system to bring an overactive immune system under control and reduce levels of inflammation in the body. These medications include prednisone, azathioprine, cyclosporine, mycophenolate mofetil, and tacrolimus, but there are many others. Herbs and supplements that ‘boost’ the immune system prevent immunosuppressants from doing their job properly. This is because they increase immune system activity while the immunosuppressant is trying to suppress it.


Remember.

Just because something is ‘natural’ doesn’t mean that it’s safe or doesn’t have side-effects. There are plenty of herbs, plants and extracts that have side-effects, can cause allergic reaction, interact with medications, be poisonous, or even prove fatal.

Keep safe!


Further information.

A warning about Polly Heil-Mealey! Sweet’s syndrome cannot be cured with herbs or homeopathic remedies.

Baking soda is not a treatment for Sweet’s syndrome or myelodysplastic syndromes.

What is the treatment for Sweet’s syndrome?

© 2012-2017 Sweet’s Syndrome UK

Can medication trigger Sweet’s syndrome?

Updated 03/03/17.

Can medication trigger Sweet’s syndrome?

Yes. In up to 5% of cases, Sweet’s syndrome is triggered by medication (Cohen, 2007). This is known as drug-induced Sweet’s syndrome.

How will you know if your Sweet’s syndrome has been triggered by medication?

In at least 95% of patients with Sweet’s syndrome, their condition is not triggered by medication. However, drug-induced Sweet’s syndrome should be considered if:

  • Your Sweet’s syndrome developed not long after a particular medication was started.
  • Your Sweet’s syndrome has continued to persist for many months or years, even after treatment.

What will happen if your doctor thinks you have drug-induced Sweet’s syndrome?

Unfortunately, there is no special test to tell you whether or not your Sweet’s syndrome is being triggered by medication. However, if it is suspected that your Sweet’s syndrome is drug-induced, your doctor will:

  • Stop the medication that is possibly causing your Sweet’s syndrome. Your Sweet’s syndrome should then start to settle down, but you may still need treatment.
  • Re-introduce the medication (rechallenge) to see if your Sweet’s syndrome flares-up again. Sometimes, your doctor will decide that this is not necessary.

Why does medication trigger Sweet’s syndrome in some people?

Drug-induced Sweet’s syndrome is often caused by hypersensitivity reaction, but it can sometimes happen for other reasons too, e.g. a treatment that increases white cell production, or causes hormonal changes. Read more here.

What is hypersensitivity reaction, and is it the same as allergic reaction?

No. Hypersensitivity reaction is not the same as allergic reaction.

Hypersensitivity reaction.

Sweet’s syndrome is caused by errors in the innate immune system  the body’s most primitive, ‘hard-wired’ immune system, and a part of the immune system that doesn’t produce antibodies. Because of these errors, in some people with Sweet’s syndrome, their innate immune system responds to antigens – mainly proteins or sugars on the surface of a cell, or a non-living substance that a part of your immune system called the adaptive immune system sees as a foreign invader and produces antibodies in response to – in a way that it shouldn’t, i.e. is hypersensitive and goes into overdrive, overreacting to the presence of infectious, inflammatory, drug, or tumour cell antigens (Bhat et al, 2015: 257; Kasirye et al, 2011: 135). This means that the presence of antigens associated with certain health conditions, medications and vaccinations can potentially trigger Sweet’s syndrome by causing the innate immune system to unnecessarily activate or activate too many inflammatory cells, mainly white blood cells called neutrophils (Gosheger et al, 2002: 70). This then leads to the symptoms of Sweet’s syndrome. Read more here.

Allergic reaction.

The most common type of allergy is an IgE-mediated allergy. This is an adverse reaction that the body has to a particular substance that is foreign to the body, e.g. a food, pollen, or pet hair, that does not normally cause harm. This substance is known as an allergen (a type of antigen). Allergic reaction occurs when the immune system mistakes an allergen for a foreign invader such as a bacteria or virus. The adaptive immune system then quickly produces allergen-specific immunoglobulin E (IgE) antibodies in response to this, in order to fight the allergen off. Chemicals such as histamine are also produced, with the overall immune response causing the symptoms of allergy.

What medications have been reported to have triggered Sweet’s syndrome?

Medications that have been reported to trigger Sweet’s syndrome include:

Analgesics (non-opioids).

  • Paracetamol (triggered a Sweet’s syndrome-like condition) (Culla et al, 2014).

Antibiotics.

  • Amoxicillin (possibly) (Volpe, 2016).
  • Clindamycin (Cruz-Velasquez et al, 2016).
  • Tetracycline.
  • Doxycycline (Ibid).
  • Minocycline (Cohen, 2007).
  • Nitrofurantoin.
  • Norfloxacin.
  • Ofloxacin.
  • Trimethoprim/sulfamethoxazole.
  • Quinupristin/dalfopristin (Ibid).
  • Piperacillin/tazobactam (Cruz- Velasquez et al, 2016).

Anti-epileptics.

  • Carbamazepine (Cohen, 2007).
  • Diazepam.

Anti-hypertensives.

  • Hydralazine (Cohen, 2007).

Anti-malarials.

  • Chloroquine (Cruz-Velasquez et al, 2016).

Anti-manic agents.

  • Lithium (Xenophontos et al, 2016).

Anti-neoplastics.

  • Bortezomib (Llamas-Velasco et al, 2015).
  • Decitabine (Kasirye et al, 2011: 134).
  • Imatinib mesylate (Cohen, 2007).
  • Ipilimumab (Gormley et al, 2014).
  • Lenalidomide (Cohen, 2007).
  • Obinutuzumab (triggered a Sweet’s syndrome-like condition) (Korman et al, 2016).

Anti-viral drugs.

  • Abacavir (Cohen, 2007).
  • Acyclovir (Cruz-Velasquez et al, 2016).
  • Interferon-α.

Colony stimulating factors.

  • Granulocyte-colony stimulating factor (G-CSF). This is the most common treatment to trigger Sweet’s syndrome (Cohen, 2007).
  • Granulocyte-macrophage-colony stimulating factor (GM-CSF).
  • Pegfilgrastim (Ibid).

Contraceptives.

  • Levonorgestrel/ethinyl estradiol (Triphasil) (Cohen, 2007).
  • Levonorgestrel-releasing intrauterine system (Mirena).

Diuretics.

  • Furosemide (Cohen, 2007).

Immunosuppressants.

  • Azathioprine (Salem et al, 2015). Sometimes, azathioprine-induced Sweet’s syndrome can be confused with azathioprine hypersensitivity syndrome (AHS) (Aleissa et al, 2017). This is a rare adverse reaction occurring a few days to weeks after azathioprine has been given. AHS can sometimes mimic Sweet’s syndrome, and an azathioprine rechallenge is not advised, as it may lead to a severe adverse reaction or even death.

Nonsteroidal anti-inflammatory drugs (NSAIDs).

  • Celecoxib (Cohen, 2007; Oh et al, 2016).
  • Rofecoxib (Cruz-Velasquez et al, 2016).
  • Diclofenac (Cohen, 2007; Gupta et al, 2015).

Platelet aggregation inhibitors.

  • Ticagrelor (Ikram and Veerappan, 2016).

Proton-pump inhibitors.

  • Esomeprazole (Cohen, 2015).
  • Omeprazole.

Psychotropics.

  • Clozapine (Cohen, 2007).
  • Amoxapine (Cruz-Velasquez et al, 2016).
  • Diazepam.
  • Lormetazepam (Ibid).

Retinoids.

  • All-trans retinoic acid (Cohen, 2007; Tam and Ingraffea, 2015).
  • 13-cis-retinoic acid (isotretinoin) (Cohen, 2007).

Sulfa drugs.

  • Sulfasalazine (Romdhane et al, 2016).

Thyroid drugs.

  • Propylthiouracil (Cruz-Velasquez et al, 2016).

Vaccinations.

  • Bacillus Calmette-Guerin (BCG or tuberculosis) (Carpentier et al, 2002: 82; Cruz-Velasquez et al, 2016). Two cases. One in 1986, occurring 15 days after vaccination, but the authors of the medical article that reported this did not control the tuberculin (Mantoux) test. One reported in 2002, occurring 10 days after vaccination.
  • Streptococcus pneumonia (Carpentier et al, 2002: 82; Cruz-Velasquez et al, 2016; Pedrosa et al, 2013). Two cases. One reported in 1990, occurring 4 days after vaccination following a splenectomy. One reported in 2013, and the first with the 13-valent conjugate vaccine.
  • Smallpox (Carpentier et al, 2002: 82; Cruz-Velasquez et al, 2016). Two cases reported in 1975, occurring 3 days after vaccination.
  • Influenza (Cruz-Velasquez et al, 2016; Hali et al, 2010, Jovanovic et al, 2005; Tan el al, 2006; Wolf et al. 2009). Four cases. One reported in 2005; in 2006, one case of bullous Sweet’s syndrome following vaccination in a HIV-infected patient; in 2009, neutrophilic dermatosis of the hands occurring 12 hours after vaccination; in 2010, one case of Sweet’s syndrome after H1N1 influenza (swine fluvaccination.

Sweet’s syndrome triggered by vaccination is incredibly rare (only 10 cases reported in medical literature in the past 42 years), and a definite connection has not been established in all the listed cases. Also, as infection is a more common trigger for Sweet’s syndrome than vaccination, you may be more likely to develop Sweet’s syndrome as a result of not having your vaccinations than having them.

If someone tells you that Sweet’s syndrome is triggered by vaccination because they are toxic or poisonous or contain dangerous chemicals, then they either have no understanding of Sweet’s syndrome and vaccinations, are not telling you the truth, or are trying to scare you, and will have no evidence to support their claims. Sweet’s syndrome triggered by vaccination occurs because of errors in the innate immune system, and this part of the immune system responding to antigens in the way that it shouldn’t. It is nothing to do with vaccines containing dangerous chemicals.

Xanthine oxidase inhibitors.

  • Allopurinol (Polimeni et al, 2015).

Other.

  • X-ray contrast agents (Cruz-Velasquez et al, 2016).

References.

Aleissa, M., Nicol, P., Godeau, M., Tournier, E., de Bellissen, F., Robic, M., Livideanu, C., Mazereeuw-Hautier, J. and Paul, C. (2017) Azathioprine Hypersensitivity Syndrome: Two Cases of Febrile Neutrophilic Dermatosis Induced by Azathioprine. Case Reports in Dermatology, Jan 19;9(1):6-11 (0nline).

Bhat, Y., Hassan, I., Sajad, P., Akhtar, S. and Sheikh, S. (2015) Sweet’s Syndrome: An Evidence-Based Report. Journal of the College of Physicians and Surgeons – Pakistan, Jul;25(7):525-7 (PubMed).

Carpentier, O., Piette, F. and Delaporte, E. (2002) Sweet’s syndrome after BCG vaccination. Acta Dermato-Venereologica;82(3):221 (PubMed).

Cohen, P. (2015) Proton pump inhibitor-induced Sweet’s syndrome: report of acute febrile neutrophilic dermatosis in a woman with recurrent breast cancer. Dermatology Practical & Conceptual, April; 5(2):113–119 (online).

Cohen, P. (2007) Sweet’s syndrome – a comprehensive review of an acute febrile neutrophilic dermatosis (online).

Cruz-Velásquez, G., Pac Sha, J., Simal Gil, E. and Gazulla, J. (2016). Aseptic meningitis and anti-β2-glycoprotein 1 antibodies in Sweet syndrome. Neurologia (Barcelona, Spain), Jul 21 (0nline). Article in Spanish, use translate.

Culla, T., Amayuelas, R., Diez-Canseco, M., Fernandez-Figueras, M., Giralt, C. and Vazquez, M. (2014) Neutrophilic dermatosis (Sweet’s syndrome-like) induced by paracetamol. Clinical and Translational Allergy, Jul; 4(Suppl 3): P83 (online).

Gormley, R., Wanat, K., Elenitsas, R., Giles, J., McGettingan, S., Schucher, L. and Takeshita, J. (2014) Ipilimumab-associated Sweet syndrome in a melanoma patient. Journal of the American Academy of Dermatology, Nov;71(5):e211-3 (online).

Gosheger, G., Hillman, A., Ozaki, T., Buerger, H. and Winklemann, W. (2002) Sweet’s Syndrome Associated With Pigmented Villonodular Synovitis. Acta Orthopædica Belgica, Feb;68(1):68-71 (PubMed).

Gupta, S., Bajpai, M. and Uraiya, D. (2015) Diclofenac-induced sweet’s syndrome. Indian Journal of Dermatology;60:424 (online).

Hali, F., Sbai, M., Benchikhi, H., Ouakadi, A. and Zamiati, S. (2010) [Sweet’s syndrome after H1N1 influenza vaccination]. Annales de Dermatologie et de Venereologie,  Nov;137(11):740-1 (PubMed).

Ikram, S. and Veerappan, V. (2016) Ticagrelor-induced Sweet Syndrome: an unusual dermatologic complication after percutaneous coronary intervention. Cardiovascular Intervention and Therapeutics, May 4th (PubMed).

Jovanovic, M., Poljacki, M., Vujanovic, L. and Duran, V. (2005) Acute febrile neutrophilic dermatosis (Sweet’s syndrome) after influenza vaccination. Journal of the American Academy of Dermatology, Feb;52(2):367-9 (PubMed).

Kasirye, Y., Danhof, R., Epperla, N. and Garcia-Montilla, R. (2011) Sweet’s Syndrome: One Disease, Multiple Faces. Clinical Medicine & Research, Nov;9(3-4):134-136 (online).

Korman, S., Hastings, J. and Byrd, J. (2016) Sweet-Like Eruption Associated With Obinutuzumab Therapy for Chronic Lymphocytic Leukemia. JAMA Dermatology, Nov 23 (online).

Llamas-Velasco, M., Concha-Garcon, M., Fraga, J. and Arageus, M. (2015) Histiocytoid sweet syndrome related to bortezomib: A mimicker of cutaneous infiltration by myeloma. Indian Journal of Dermatology, Venereology and Leprology, May;81:305-6 (online).

Oh, E., Shin, J., Hong, J., Kim, J., Ro, Y. and Ko, J. (2016) Drug-induced bullous Sweet’s syndrome by celecoxib. The Journal of Dermatology, Apr 6 (PubMed).

Pedrosa, A., Morais, P., Nogueira, A., Pardal, J. and Azevedo, F. (2013) Sweet’s syndrome triggered by pneumococcal vaccination. Cutaneous and Ocular Toxicology, Sep;32(3):260-1 (PubMed).

Polimeni. G., Cardillo, R., Garaffo, E., Giardina, C., Macrì, R., Sirna, V.,  Guarneri, C. and Arcoraci, V. (2015) Allopurinol-induced Sweet’s syndrome. International Journal of Immunopathology and Pharmacology, Dec 18th (PubMed).

Romdhane, H., Mokni, S., Fathallah, N., Ghariani, N., Sriha, B. and Salem, B. (2016) Sulfasalazine-induced Sweet’s syndrome. Therapie, Jun;71(3):345-347 (PubMed).

Salem, C., Larif, S., Fathallah, N., Slim, R., Aounallah, A. and Hmouda, J. (2015) A rare case of azathioprine-induced Sweet’s syndrome in a patient with Crohn’s disease. Current Drug Safety, July (PubMed online).

Tam, C. and Ingraffea, A. (2015) Case Letter: Sweet Syndrome Presenting With an Unusual Morphology. Cutis, Aug;96(2):E9-E10 (online).

Tan, A., Tan. H., and Lim, P. (2006) Bullous Sweet’s syndrome following influenza vaccination in a HIV-infected patient. International Journal of Dermatology, Oct;45(10):1254-5 (PubMed). 

Volpe, M. (2016) Sweet Syndrome Associated with Upper Respiratory Infection and Amoxicillin Use. Cureus, Apr; 8(4): e568 (online).

Wolf, R., Barzilai, A. and Davidovici, B. (2009) Neutrophilic dermatosis of the hands after influenza vaccination. International Journal of Dermatology, Jan;48(1):66-8 (PubMed).

Xenophontos, E., Ioannou, A., Constantinides, T. and Papanicolaou. E. (2016) Sweet syndrome on a patient with autoimmune hepatitis on azathioprine and CMV infection. Oxford Medical Case Reports, Feb; (2): 24–27 (online).

Other information.

Cetin, G., Sayarlioglu, H., Erhan, C., Kahraman, H., Ciralik, H. and Sayarlioglu, M. (2014) A case of neutrophilic dermatosis who develop palpable purpura during the use of montelukast. European Journal of Dermatology,  Dec; 1(4): 170–171 (online).

© 2012-2017 Sweet’s Syndrome UK

Baking soda is not a treatment for Sweet’s syndrome or myelodysplastic syndromes

Updated 26/01/17.

In 15-20% of patients with Sweet’s syndrome (SS), their condition develops secondary to some form of blood disorder or cancer, particularly a group of blood disorders called myelodysplastic syndromes (MDS). Depending on what type of MDS you have, MDS may cause problems such as anaemia (a low number of red blood cells) or more severe problems such as leukaemia (a type of blood cancer).

Is baking soda a treatment for Sweet’s syndrome or myelodysplastic syndromes?

No. Baking soda, otherwise known as sodium bicarbonate, is not a treatment for SS or MDS.

Recently, sodium bicarbonate has been advocated as a treatment for SS and/or MDS, including by Melissa Mendez who is a transformational nutrition coach with a website called The Pure Appeal (United States). She also has SS and MDS, but has no background in health care or science.

This idea that sodium bicarbonate is an effective treatment for SS and/or MDS is a potentially dangerous claim that is not supported by medical research, and if you have SS or/and MDS, you will need proper medical treatment. In some cases, if you do not receive proper medical treatment, this could result in you becoming seriously ill or even losing your life.

A doctor by the name of Tullio Simoncini is treating patients who have MDS and cancer with sodium bicarbonate. If he’s a doctor, doesn’t that mean it works?

No. Dr. Simoncini, who Melissa Mendez is a supporter of, is a former Italian doctor and known fraudster, and his practice is incredibly dangerous. In 2003, he was struck off the medical register for treating cancer patients with sodium bicarbonate instead of chemotherapy. In 2006, he was found guilty of fraud and manslaughter after a patient died as a result of using his treatments.

Unfortunately, Dr. Simoncini is continuing to tell people that MDS and cancer can be cured with sodium bicarbonate, despite the fact that there is no and has never been any medical research to support his claims. This pseudoscientific claim (false or made-up claim that appears to be scientifically based, but is not) is based on the idea that cancer is caused by Candida (fungus) or Candida albicans which causes the common fungal infection ‘thrush’, and that the body develops cancer in an attempt to protect itself from fungal infection. Sodium bicarbonate supposedly gets rid of the Candida and therefore cures the cancer. This is completely untrue. Cancer is not caused by Candida, and sodium bicarbonate isn’t even a treatment for fungal infections, let alone cancer.

Please treat anyone who advocates, promotes, sells or prescribes sodium bicarbonate as a treatment for MDS and leukaemia and other forms of cancer, with extreme caution. Also, remember that it is not a treatment for SS!

Is it true that an acidic diet can cause cancer, or that an alkaline diet can cure cancer or Sweet’s syndrome? Do I need to take baking soda to make my diet or body more alkaline?

On The Pure Appeal website (22/03/16), Melissa Mendez states that:

‘If baking soda can alter the ph of the body (make it more alkaline) to encourage healing, and it was clearly helping one of the rarest skin disorders (implying that it healed her Sweet’s syndrome), what does this mean for MDS?

Baking soda is almost like the magic bullet to jumpstart your body into full on healing mode. Cancers can not grow in an alkaline state. Even malignant tumors are incredibly acidic, so it only makes sense to go to the opposite end of the spectrum, if you want your body to heal.’

The information that Melissa Mendez has posted is inaccurate and makes no biological sense whatsoever. There is no evidence that an acidic diet can cause cancer or SS, or that an alkaline diet can cure cancer or SS or promote healing. The overall pH or potential hydrogen (pH tells us how acidic or alkaline a liquid is) of the body cannot be altered simply by changing your diet or adding things to it, i.e. make it more or less alkaline or acidic by consuming certain foods, substances or drinks. To begin with, your blood is slightly alkaline anyway, and this is tightly regulated by the kidneys which keep the pH within a normal and narrow range. The pH can’t be changed for any significant amount of time by what you consume, and any extra acid or alkali is simply peed out in urine. It is true that cancer cells are unable to live in a very alkaline environment, but neither can any other cells in the body. Therefore, if an alkaline diet did really have the ability to change the pH of your body, then it would probably kill you.

Even though you say that sodium bicarbonate isn’t a treatment for SS or/and MDS, if I want to try it, is it safe to use?

Sodium bicarbonate can be safe to use, and is commonly given as an antacid, i.e. to reduce stomach acid, but is sometimes used to treat other health conditions too. However, it is not always safe to use, particularly when taken in larger doses. This may be because of side-effects, certain health conditions or medications, pregnancy or breastfeeding. If given in high doses, the consequences may be serious or even fatal.

How is sodium bicarbonate given?

Sodium bicarbonate can be given orally (via the mouth), as an intravenous injection (injection into a vein), or as an intravenous infusion (into a vein via a drip). The way in which it is given depends on what kind of condition the sodium bicarbonate is being used to treat.

What are the side-effects of sodium bicarbonate?

Side-effects can depend upon how the sodium bicarbonate is given but may include:

  • Nausea.
  • Bloating.
  • Flatulence.

Less commonly:

  • Swelling of the hands, ankles and feet.
  • Sudden weight gain.

Rarely:

  • Dizziness.
  • Muscle aches and spasms.
  • Mental or mood changes, e.g. confusion, irritability or memory problems.
  • Vomiting.
  • General weakness.
  • Passing significantly more or less urine.
  • Chest pain.
  • Seizures.
  • When taken with lots of calcium (in the diet, medications or supplements), may cause milk-alkali syndrome.

In which health conditions should sodium bicarbonate be avoided or used with caution?

NOT TO BE USED in those with the following health conditions:

  • Certain breathing problems, e.g. pulmonary oedema.
  • Congestive heart failure.
  • Severe kidney disease.
  • Severe liver disease.
  • High sodium levels.
  • Swollen ankles, legs or feet due to retaining water (peripheral oedema).

To be used with CAUTION in those with:

  • Low calcium levels.
  • High blood pressure.
  • Heart problems.
  • Kidney disease.

Also, to be used with caution or avoided in those who are on a low-salt diet, pregnant or breastfeeding.

Which medications can be affected by sodium bicarbonate?

When taken orally in particular, sodium bicarbonate can interact with and should NOT BE USED if you are taking the following medications:

  • Aspirin and other salicylates, e.g. salsalate.
  • Barbiturates, e.g. phenobarbital.
  • Calcium supplements.
  • Corticosteroids (steroids), e.g prednisone.
  • Memantine.
  • Medications with a special coating to protect the stomach (enteric coating).
  • Lithium.
  • Quinidine.
  • Water pills (thiazide diuretics such as hydrochlorothiazide).

Reduces the effectiveness of and to be used with CAUTION when taking the following medications:

  • Certain drugs that require stomach acid to work, including ampicillin.
  • Atazanavir.
  • Certain azole antifungals (such as ketoconazole, itraconazole).
  • Iron supplements.
  • Pazopanib.
  • Sucralfate.

Sodium bicarbonate may also interact or reduce the effectiveness of some other medications, or should not be used in patients with health conditions that have not been listed above. Please speak to your doctor before use.

Additional note.

Sweet’s Syndrome UK does not promote the use of alternative or nutritional therapies. This is because there is no medical evidence to show that these therapies are effective, or sometimes even safe to use in those with Sweet’s syndrome. If anyone does have information that proves that alternative or nutritional therapies can be used to treat Sweet’s syndrome, I will be more than happy to read it. However, only peer-reviewed medical articles and case-studies will be accepted as evidence. The following will not be accepted as evidence: anecdotal evidence or personal stories; testimonials; YouTube videos; information on blogs or websites where there are no references or links to peer-reviewed medical articles or case-studies, or where the author is not willing to provide this information; blogs or websites where someone tries to pass off their feelings or instincts, beliefs or opinions as facts or evidence.

Thank you.

Michelle Holder.

Other information.

A warning about Polly Heil-Mealey! Sweet’s syndrome cannot be cured with herbs or homeopathic remedies.

Childs, O. (2014) Don’t Believe the Hype – 10 Persistent Cancer Myths Debunked. Cancer Research UK (online).

Chlorella is not a treatment for Sweet’s syndrome.

MDS UK Patient Support Group.

Smith, E. (2015) Alternative therapies: what’s the harm? Cancer Research UK (online). 

© 2012-2017 Sweet’s Syndrome UK

Bilateral Sensorineural Hearing Loss and Polyneuropathy in Sweet’s Syndrome

Links checked 2/03/17.

This is a very interesting case-study reporting bilateral sensorineural hearing loss and polyneuropathy in a patient with Sweet’s syndrome (Cala et al, 2015).

A 54-year-old man went to clinic with ulcers on his fingers along with symptoms suggesting a neurological problem, e.g. numbness and pins and needles in the extremities (hands and feet). He also had rapidly progressive hearing loss. Four years earlier, he had been diagnosed with Sweet’s syndrome (SS) by another clinic after developing skin lesions involving all four extremities. He did not recall having any neurological symptoms at that time. A biopsy (tissue sample) of the lesions had shown a dense neutrophilic infiltrate (lots of white blood cells called neutrophils in the tissues) and an absence of vasculitis (no inflammation of the vessels). These biopsy results suggested SS, and the patient was started on oral prednisone and given steroid injections as necessary to treat any new lesions. Dapsone gel and silver sulfadiazine (an antibacterial agent) were also used to help treat the lesions and reduce the risk of infection. However, an ulcerated finger became badly infected and needed to be amputated.

Over the next few months, after his latest visit to the clinic, the patient started to develop new lesions on his skin. The numbness and pins and needles in his feet also started to get worse, and would later affect the hands. Cerebrospinal fluid analysis (CSF) showed a normal white blood cell count. This is usually raised in neuro-Sweet’s disease – a neurological variant of Sweet’s syndrome that affects the brain and spinal cord. A serum immunofixation electrophoresis blood test suggested that the patient had probably developed SS secondary to monoclonal gammopathy of unknown significance (MGUS). Other tests included nerve conduction and a nerve biopsy, and the results of these tests showed that the patient had developed polyneuropathy. This is a condition that affects the peripheral nerves in roughly the same areas on both sides of the body. It is caused by disease or damage to the nerves that lie outside of the central nervous system, i.e. the brain and spinal cord. The patient was then evaluated for his worsening hearing loss which was causing dizziness and tinnitus (‘ringing in the ears’ or other sounds). A hearing test known as an audiogram revealed serious sensorineural hearing loss in both ears, despite the fact that no abnormalities had been shown on a MRI scan. Sensorineural hearing loss is a form of hearing impairment that is caused by damage to the nerves in the inner ear.

It was eventually determined that all of the patient’s symptoms were probably caused by SS. After treatment with azathioprine and intravenous immunoglobulin (IVIg), his skin lesions started to settle, and his polyneuropathy also started to improve as a result of the IVIg. However, his hearing loss did not improve, even after additional treatment with mycophenolate mofetil, cyclosporine, pregabalin, gabapentin, and nortriptyline. Only after cochlear implants did some, but not all, of his hearing return.

Please note that the majority of Sweet’s syndrome patients will not develop hearing loss or polyneuropathy as a result of their condition.

References.

Cala, C. , Kole, L. and Sami, N. (2015) Bilateral Sensorineural Hearing Loss and Polyneuropathy in a Patient with Sweet’s Syndrome. Case Reports in Otolaryngology, Dec 6th (Hindawi).

Further information.

Action on Hearing Loss (2017) Cochlear Implants (online). Accessed 2/03/17.

Macmillan Cancer Support (2017) General information: MGUS (online). Accessed 2/03/17.

NHS Choices (2015) Hearing Loss – Causes (online). Last reviewed on 22/04/15. Includes information on sensorineural hearing loss.

NHS Choices (2016) Peripheral Neuropathy (online). Last reviewed on 16/05/16. Includes information on polyneuropathy.

What is the treatment for Sweet’s syndrome?

© 2012-2017 Sweet’s Syndrome UK

 

Chlorella is NOT a treatment for Sweet’s syndrome

Links checked on 2/04/17.

Can or should chlorella be used to treat Sweet’s syndrome?

No. Despite the fact that some alternative therapists have started recommending and using the algae chlorella as a treatment for Sweet’s syndrome (SS), there is no medical evidence to prove that it is either safe or effective.

Please be very wary of any alternative therapist that tells you that SS can be treated or cured with chlorella. They are either lying to you or don’t know anything about SS, and are not doing what’s in your best interests.

Chlorella is ‘natural’. Does that mean that it doesn’t have side-effects?

No. Just because chlorella is ‘natural’ doesn’t mean that it doesn’t have side-effects.

The most common side-effects include:

  • Diarrhoea.
  • Nausea.
  • Flatulence.
  • Green-coloured stools.
  • Stomach cramps.

Other problems.

Allergic reaction.

Common symptoms of an allergic reaction to chlorella include:

  • Redness.
  • Itching.
  • Hives.
  • Skin rash.
  • Swelling of the face and mouth.

Chlorella can also cause a SERIOUS ALLERGIC REACTION known as anaphylaxis, and symptoms include:

  • Wheezing.
  • Difficulty breathing.
  • Difficulty swallowing.
  • Confusion.
  • Fainting.
  • Loss of consciousness.
  • Possible death.

Photosensitivity.

Chlorella causes the skin to become extra-sensitive to the sun. This is known as photosensitivity. Some patients with SS will already be extra-sensitive, and overexposure to sunlight or ultraviolet (UV) light can potentially trigger a flare-up (read more here). Certain medications used to treat SS, e.g. dapsone and tetracycline antibiotics such as doxycycline and minocycline, can also increase sensitivity.

Are there some people who should avoid using chlorella?

Yes. There are some people who should completely avoid using chlorella, and these include:

  • Women who are pregnant or breast-feeding: chlorella has not been proven safe to use, and could potentially harm the baby.
  • Those with iodine sensitivity: chlorella contains iodine, and this can lead to an allergic reaction.
  • Those with an allergy to mold: they are much more likely to have an allergic reaction.
  • Those with a weak immune system (immunodeficiency): chlorella can cause ‘bad’ bacteria to take-over in the intestine of people who have a weak immune system.
  • Those with autoimmune, and possibly autoinflammatory conditions: autoimmune and autoinflammatory conditions are caused by an overactive and not an underactive immune system – an overactive adaptive immune system in autoimmune conditions and an overactive innate immune system in autoinflammatory conditions. Chlorella has been proven to ‘boost’ the immune system, i.e. increase immune system activity or make it more active. This can cause an overactive immune system to become even more overactive, potentially making autoimmune conditions worse. Evidence is needed before we know if chlorella can negatively affect those with autoinflammatory conditions such as Sweet’s syndrome, but as yet, no research has been conducted. However, it is important to remember that Sweet’s syndrome can develop secondary to autoimmune conditions, and if this is the case, when the autoimmune condition flares-up the Sweet’s syndrome often does too.

Is it safe to take chlorella alongside medications?

No, not always. Chlorella can interact with or prevent certain medications from working properly.

DO NOT use chlorella if you are taking the following medications:

  • Immunosuppressents: these are medications that suppress or ‘dampen down’ the immune system to bring an overactive immune system under control and reduce levels of inflammation in the body. These medications include prednisone, azathioprine, cyclosporine, mycophenolate, and tacrolimus, but there are many others. Supplements such as chlorella that ‘boost’ the immune system prevent immunosuppressants from doing their job properly. This is because they increase immune system activity while the immunosuppressant is trying to suppress it.
  • Warfarin – an anticoagulant: warfarin thins the blood and stops it from clotting, and is commonly used to treat conditions such as heart attack, deep vein thrombosis, and pulmonary embolism. Chlorella contains large amounts of vitamin K. This is used by the body to help the blood clot, and prevents the warfarin from working properly.

There is very little reliable information on chlorella. It should never be taken for more than 2 months as there are no proper studies on the long term side-effects. This means that it may not be safe to use in the longer term.

Also, remember that just because something is ‘natural’ doesn’t mean that it’s safe or doesn’t have side-effects. There are plenty of herbs, plants and extracts that have side-effects, can cause allergic reaction, interact with medications, be poisonous, or even prove fatal.

Keep safe!

Further information.

A warning about Polly Heil-Mealey! Sweet’s syndrome cannot be cured with herbs or homeopathic remedies.

Baking soda is not a treatment for Sweet’s syndrome or myelodysplastic syndromes.

Herbs and supplements that should be avoided or used with caution in Sweet’s syndrome.

What is the treatment for Sweet’s syndrome?

© 2012-2017 Sweet’s Syndrome UK

Differentiation syndrome and Sweet’s syndrome: is there a connection?

Links checked on 2/03/17.

Is there a connection between differentiation syndrome and Sweet’s syndrome?

By February 2015, only three cases of Sweet’s syndrome had been reported in patients with differentiation syndrome which occurred as a result of treatment with all trans-retinoic acid (ATRA) for acute promyelocytic leukaemia (Salono-Lopez et al, 2015).

What is acute promyelocytic leukaemia?

Acute promyelocytic leukaemia (APL) is a form of blood cancer that affects a type of white blood cell called the myeloid cell. It is more common in older adults than younger adults, and is rare in young children.

What is differentiation syndrome?

Differentiation syndrome, formally known as retinoic acid syndrome, is a potentially life-threatening condition that mainly occurs as a result of treatment with ATRA or arsenic trioxide for APL. It occurs in approximately 25% of patients with APL receiving these treatments during induction therapy – the first phase of chemotherapy where the aim is to get rid of as many leukaemia cells as possible.

What are the symptoms of differentiation syndrome?

Symptoms of differentiation syndrome include fever; low blood pressure; shortness of breath; weight gain of more than 5 kg; abnormal findings in the lungs on chest x-ray or scan (Montesinos and Sanz, 2011). Less common and rare symptoms include swollen feet and ankles as a result of fluid building up in the tissues; bone, muscle or nerve pain; Sweet’s syndrome; kidney or liver problems; fluid around the heart.

Can ATRA therapy also cause Sweet’s syndrome?

Yes.

In up to 5% of cases, Sweet’s syndrome can be triggered by medication (drug-induced). The most common medication is G-CSF (granulocyte-colony stimulating factor), but it can also be triggered by other medications, including ATRA. The reason as to why some medications can trigger Sweet’s syndrome is still poorly understood, buy may involve hypersensitivity reaction.

Is there a connection between differentiation syndrome and Sweet’s syndrome?

Possibly.

There is debate over whether or not differentiation syndrome and Sweet’s syndrome are completely separate conditions or are part of the same disease spectrum. This is because they share some common features. These include fever, white blood cells called neutrophils infiltrating the tissues, and improvement after steroid therapy. However, there are also some differences. Unlike in differentiation syndrome, Sweet’s syndrome does not commonly affect internal organs, and is not associated with capillary leak syndrome. This is a rare and life-threatening condition that has been suggested as a potential cause for differentiation syndrome. It causes endothelial cells lining small blood vessels called capillaries to separate, allowing fluid to leak into the space between the cells. This eventually leads to symptoms such as a rapid drop in blood pressure; shock; sudden swelling of the arms or legs, and other parts of the body; lightheadedness; weakness; fatigue; feeling sick; fluid around the heart and lungs; high percentage of red blood cells in the blood; low levels of protein in the blood.

Further research is required.

Please note that Sweet’s syndrome as a symptom of differentiation syndrome is very rare.

References.

Montisenos, P. and Sanz, M. (2011) The Differentiation Syndrome in Patients with Acute Promyelocytic Leukemia: Experience of the Pethema Group and Review of the Literature. Mediterranean Journal of Hematology and Infectious Diseases, Dec;3(1):e2011059 (online).

Solano-López, G., Llamas-Velasco, M., Concha-Garzón, M. and Daudén, E. (2015) Sweet syndrome and differentiation syndrome in a patient with acute promyelocytic leukemia. World Journal of Clinical Cases, Feb 16;3(2):196-8 (online).

© 2012-2017 Sweet’s Syndrome UK