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Subcutaneous Sweet’s syndrome associated with the onset of Behcet’s disease
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"en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Letter</span>" "titulo" => "Subcutaneous Sweet’s syndrome associated with the onset of Behcet’s disease" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "644" "paginaFinal" => "645" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Pablo Vargas-Mora, Fernando Valenzuela, Viera Kaplan, Laura Carreño" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Pablo" "apellidos" => "Vargas-Mora" "email" => array:1 [ 0 => "pablovargas.med@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Fernando" "apellidos" => "Valenzuela" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Viera" "apellidos" => "Kaplan" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Laura" "apellidos" => "Carreño" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile." "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Pathology Service, Hospital Clínico Universidad de Chile, Santiago, Chile." "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2023 "Ancho" => 1508 "Tamanyo" => 195898 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous subcutaneous nodules in thighs and legs.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Sweet Syndrome (SS) is the most frequent of neutrophilic dermatoses.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Some rare variants have been described, such as subcutaneous SS, which clinically usually presents with inflammatory nodules similar to erythema nodosum.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Behçet’s Disease (BD) is a multisystemic disease with many symptoms, presenting papules, pustules, or erythema nodosum-like lesions on the skin.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present a case of subcutaneous SS and BD in the same patient, given its extremely rare association.</p><p id="par0015" class="elsevierStylePara elsevierViewall">A healthy 72-year-old woman consults for painful erythematous nodules in the extremities of two weeks’ evolution, associated with fever and arthralgias. Physical examination reveals erythematous subcutaneous nodules on the extremities, arthritis, and oral ulcers (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). Laboratory tests: hemogram of 5,850 leucocytes/L (80% neutrophils), erythrocyte sedimentation rate 70 mm/hr, C-reactive protein 158 mL/L. Glycemia, hepatic, renal and thyroid functions are normal. Viral serology (Hepatitis B and C, HIV), blood and urine cultures, <span class="elsevierStyleItalic">Mycoplasma pneumoniae</span> serology, autoimmunity studies all negative. A skin biopsy revealed neutrophilic dermohypodermitis, mixed panniculitis, with vasculitis of the medium-small vessels (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). With these findings, a diagnosis of subcutaneous SS was postulated, and prednisone 0.5 mg/kg/day was indicated. The patient evolved with no fever and there was complete resolution of the cutaneous lesions after 72 hours of treatment. However, she evolves with a red-eye involvement. Ophthalmic evaluation confirmed intermediate uveitis. HLA-B51 was positive. Given these findings, added to the history of recurrent oral ulcers, BD was diagnosed, and treatment was begun with monthly pulses of cyclophosphamide 300 mg. There was a favorable evolution and complete remission after the first pulse.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Subcutaneous SS fulfilled the same spectrum of neutrophilic panniculitis.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Our patient complied with the modified diagnostic criteria of SS (Su and Liu)<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and also complied with the diagnostic criteria of BD (International Study Group).<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">There are few reports on the association of both dermatoses.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> According to the literature reviewed, the present report is the first case of the subcutaneous variant of SS associated with BD. In histopathological series of SS, the presence of vasculitis has been reported in up to 73% of cases.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> On the other hand, series of 26 cases of erythema nodosum-like in the context of BD, it was found that 73% had no classical findings of erythema nodosum, but rather mixed or lobular panniculitis with the presence of vasculitis and in several cases an abundant infiltrate of neutrophils.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> This suggests that some of these patients might comply with the criteria for subcutaneous SS, and that the superimposition of BD could lead to SS being under-diagnosed.</p><p id="par0030" class="elsevierStylePara elsevierViewall">We think that the relationship between both diseases is more than a mere coincidence. SS might represent a marker for Behçet’s activity, as in the majority of reported cases it presents in the acute phase or prior to an exacerbation, which is correlated to the clinical evolution of our patient.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Future studies are needed aiming at the wide clinical variability of both diseases and the way they relate to each other, which is probably in a continuum within the spectrum of the still poorly understood neutrophilic dermatoses.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0040" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors’ contributions</span><p id="par0045" class="elsevierStylePara elsevierViewall">Pablo Vargas-Mora: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; obtaining, analyzing, and interpreting the data; effective participation in research orientation; critical review of the literature; critical review of the manuscript.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Fernando Valenzuela: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; obtaining, analyzing, and interpreting the data; effective participation in research orientation; critical review of the literature; critical review of the manuscript.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Viera Kaplan: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; obtaining, analyzing, and interpreting the data; effective participation in research orientation; critical review of the manuscript.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Laura Carreño: Approval of the final version of the manuscript; conception and planning of the study; obtaining, analyzing, and interpreting the data; effective participation in research orientation; critical review of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors’ contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-04-20" "fechaAceptado" => "2020-07-05" "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Vargas-Mora P, Valenzuela F, Kaplan V, Carreño L. Subcutaneous Sweet’s syndrome associated with the onset of Behcet’s disease. An Bras Dermatol. 2021;96:644–5.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Hospital Clínico, Universidad de Chile, Santiago, Chile.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2023 "Ancho" => 1508 "Tamanyo" => 195898 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous subcutaneous nodules in thighs and legs.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1455 "Ancho" => 1508 "Tamanyo" => 185623 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Oral ulcers.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 681 "Ancho" => 905 "Tamanyo" => 213866 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Neutrophilic inflammatory infiltrate in the hypodermis and vascular wall, (Hematoxylin & eosin, ×40).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neutrophilic dermatoses: Pathogenesis, Sweet syndrome, neutrophilic eccrine hidradenitis, and Behçet disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C.A. 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| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 17 | 6 | 23 |
| 2024 Outubro | 117 | 71 | 188 |
| 2024 Setembro | 164 | 77 | 241 |
| 2024 Agosto | 160 | 117 | 277 |
| 2024 Julho | 147 | 115 | 262 |
| 2024 Junho | 114 | 87 | 201 |
| 2024 Maio | 106 | 74 | 180 |
| 2024 Abril | 111 | 94 | 205 |
| 2024 Março | 95 | 67 | 162 |
| 2024 Fevereiro | 107 | 94 | 201 |
| 2024 Janeiro | 98 | 51 | 149 |
| 2023 Dezembro | 78 | 62 | 140 |
| 2023 Novembro | 79 | 78 | 157 |
| 2023 Outubro | 58 | 75 | 133 |
| 2023 Setembro | 76 | 80 | 156 |
| 2023 Agosto | 61 | 39 | 100 |
| 2023 Julho | 77 | 38 | 115 |
| 2023 Junho | 52 | 33 | 85 |
| 2023 Maio | 50 | 19 | 69 |
| 2023 Abril | 39 | 16 | 55 |
| 2023 Março | 60 | 48 | 108 |
| 2023 Fevereiro | 46 | 40 | 86 |
| 2023 Janeiro | 51 | 29 | 80 |
| 2022 Dezembro | 57 | 31 | 88 |
| 2022 Novembro | 73 | 62 | 135 |
| 2022 Outubro | 110 | 56 | 166 |
| 2022 Setembro | 62 | 68 | 130 |
| 2022 Agosto | 48 | 48 | 96 |
| 2022 Julho | 53 | 64 | 117 |
| 2022 Junho | 58 | 49 | 107 |
| 2022 Maio | 54 | 52 | 106 |
| 2022 Abril | 70 | 60 | 130 |
| 2022 Março | 87 | 62 | 149 |
| 2022 Fevereiro | 35 | 35 | 70 |
| 2022 Janeiro | 80 | 80 | 160 |
| 2021 Dezembro | 64 | 74 | 138 |
| 2021 Novembro | 58 | 49 | 107 |
| 2021 Outubro | 116 | 98 | 214 |
| 2021 Setembro | 101 | 93 | 194 |
| 2021 Agosto | 29 | 36 | 65 |
| 2021 Julho | 3 | 8 | 11 |
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