Giant Cellulitis-Like Sweet’s Syndrome

Updated 7/06/17.

Sometimes, Sweet’s syndrome can occur in an unusual form. This is known as a disease variant.

What is cellulitis and cellulitis-like Sweet’s syndrome?

Cellulitis is a bacterial infection of the skin. On occasion, it can trigger Sweet’s syndrome or look like Sweet’s syndrome (Crum et el, 2003; Dinh et al, 2007; Morgan and Callen, 2001; Resende et al, 2016; Shugarman et al, 2011).

Sweet’s syndrome that looks like cellulitis is called cellulitis-like Sweet’s syndrome. It usually affects one part of the body, and is sometimes associated with blood disorders and cancer.

What is giant cellulitis-like Sweet’s syndrome?

Giant cellulitis-like Sweet’s syndrome is a rare variant of Sweet’s syndrome that affects a larger part of the body than cellulitis-like Sweet’s syndrome, and there have only been 7 cases reported in medical literature (Guzman and Paliza, 2017; Kaminska et al, 2014; Koketsu et al, 2014; So et al, 2015; Surovy et al, 2013b). It most commonly causes giant, raised-red skin lesions that have a swollen appearance (bullae or bullous lesions), but can cause other lesion types too (Guzman and Paliza; So et al, 2015; Surovy et al, 2013a). It appears to be associated with obesity, sometimes blood disorders and cancer, and one case has been reported in a patient with the autoimmune condition Sjögren’s syndrome, also known as Sicca syndrome (Kaminska et al, 2014; Surovy et al, 2013b). In 2015, the first case of histiocytoid giant cellulitis-like Sweet’s syndrome was reported in a patient with myelodysplastic syndromes and myeloproliferative disorder (So et al, 2015). In 2017, another case of giant cellulitis-like Sweet’s syndrome was reported in a morbidly obese woman with acute myeloid leukaemia, and was initially misdiagnosed as cellulitis (Guzman and Paliza, 2017). In this case, lesions that evolved into giant bullae were on the front of both legs, other lesion types developed on the face, back and upper extremeties, and bullous lesions also appeared at a previous intravenous site. When skin lesions develop in an area where skin damage or irritation has occurred, e.g. where a cannula or ‘tube’ has been inserted into a vein (intravenous), the skin has been scratched or something applied to the skin has caused irritation, this is referred to as pathergy.

How is it diagnosed?

Giant cellulitis-like Sweet’s syndrome is diagnosed in the same way as Sweet’s syndrome. A  swab of a skin lesion can also be sent for culture to rule out cellulitis and infection as a cause (Cohen, 2007). Read more HERE.

How is it treated?

Just like Sweet’s syndrome, the main form of treatment for giant cellulitis-like Sweet’s syndrome is corticosteroid (steroid) medication, but the sulfa drug, dapsone, has also been used (Koketsu et al, 2014). Read more HERE.

References.

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

Crum, N., Higginbottom, P., Fehl, F. and Graham, B. (2003) Sweet’s syndrome masquerading as facial cellulitis. Cutis, Jun;71(6):469-72 (PubMed).

Dinh, H., Murugasu, A. and Gin, D. (2007) Sweet’s syndrome associated with cellulitis. The Australasian Journal of Dermatology, May;48(2):105-9 (PubMed).

Guzman, A. and Paliza, A. (2017) Giant cellulitis-like bullous Sweet’s syndrome: A rare variant. Journal of the American Academy of Dermatology, Jun;76(6)(Suppl 1):AB145 (online).

Kaminska, E., Nwaneshiudu, A., Luzuriaga, A., Tsoukas, M. and Bolotin, D. (2014) Giant cellulitis-like Sweet syndrome in the setting of autoimmune disease. Journal of the American Academy of Dermatology, Sept;71(3): e94–e95 (online).

Koketsu, H. Ricotti, C, and Kerdel, F. (2014) Treatment of giant cellulitis-like Sweet syndrome with dapsone. JAMA Dermatology, Apr;150(4):457-9 (online).

Morgan, K. and Callen, J. (2001) Sweet’s syndrome in acute myelogenous leukemia presenting as periorbital cellulitis with an infiltrate of leukemic cells. Journal of American Academy of Dermatology, Oct;45(4):590-5 (PubMed).

Resende, C., Santos, R., Pereira, T. and Brito, C. (2016) Sweet’s syndrome associated with cellulitis – a challenging diagnosis. Anais Brasileiros de Dermatologia, Jan-Feb; 91(1): 94–96 (online).

Shugarman, I., Schmit, J., Sbicca, J. and Wirk, B. (2011) Easily Missed Extracutaneous Manifestation of Malignancy-Associated Sweet’s Syndrome: Systemic Inflammatory Response Syndrome. American Society of Clinical Oncology, Aug 20; 29(24)(online).                                    

So, J., Carlos, C., Frucht, C. and Cohen, P. (2015) Histiocytoid giant cellulitis-like Sweet’s syndrome: case report and review of the literature. Dermatology Online Journal, Jan 25;21(3) (PubMed).

Surovy, A., Pelivani, N., Hegyi, I., Buettiker, U., Beltraminelli, H. and Borradori, L. (2013a) Figure 2, A., B., and C., in Giant Cellulitis-like Sweet Syndrome, a New Variant of Neutrophilic Dermatosis, JAMA Dermatology, Jan; 149(1):79-83 (online).

Surovy, A., Pelivani, N., Hegyi, I., Buettiker, U., Beltraminelli, H. and Borradori, L. (2013b) Giant Cellulitis-like Sweet Syndrome, a New Variant of Neutrophilic Dermatosis, JAMA Dermatology, Jan; 149(1):79-83 (online).

© 2012-2017 Sweet’s Syndrome UK

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