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Subcutaneous Sweet's syndrome: A variant of acute febrile neutrophilic dermatosis that is included in the histopathologic differential diagnosis of neutrophilic panniculitis

2005; Elsevier BV; Volume: 52; Issue: 5 Linguagem: Inglês

10.1016/j.jaad.2005.03.001

1097-6787

Philip R Cohen,

Autoimmune Bullous Skin Diseases

To the Editor: Sutra-Loubet et al1Sutra-Loubet C. Carlotti A. Guillemette J. Wallach D. Neutrophilic panniculitis.J Am Acad Dermatol. 2004; 50: 280-285Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar recently: (1) reported a patient in whom the "…histologic picture led to the diagnosis of neutrophilic panniculitis"; (2) reviewed the features of seven other patients whom they consider to also have a diagnosis of neutrophilic panniculitis; and (3) suggested that "…neutrophilic panniculitis is a distinct entity, different from other panniculitis and also from other neutrophilic dermatoses, including Sweet's syndrome." However, in my opinion: (1) the patient described by Sutra-Loubet et al has subcutaneous Sweet's syndrome; (2) five (and possibly six) of the patients whose features were reviewed by Sutra-Loubet et al also have a diagnosis of subcutaneous Sweet's syndrome; and (3) neutrophilic panniculitis is not a distinct entity but a concise pathologic description of specific changes in the subcutaneous fat that have been observed in association with several conditions. Subcutaneous Sweet's syndrome is a variant of acute febrile neutrophilic dermatosis in which the pathologic changes are either localized within only the adipose tissue1Sutra-Loubet C. Carlotti A. Guillemette J. Wallach D. Neutrophilic panniculitis.J Am Acad Dermatol. 2004; 50: 280-285Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar, 2Cooper P.H. Frierson H.F. Greer K.E. Subcutaneous neutrophilic infiltrates in acute febrile neutrophilic dermatosis.Arch Dermatol. 1983; 119: 610-611Crossref PubMed Scopus (52) Google Scholar, 3Cullity J. Maguire B. Gebauer K. Sweet's panniculitis.Australas J Dermatol. 1991; 32: 61-64Crossref PubMed Scopus (23) Google Scholar, 4Cohen P.R. Kurzrock R. Sweet's syndrome revisited: a review of disease concepts.Int J Dermatol. 2003; 42: 761-778Crossref PubMed Scopus (336) Google Scholar, 5Cohen P.R. Kurzrock R. Sweet's syndrome: a review of current treatment options.Am J Clin Dermatol. 2002; 3: 117-131Crossref PubMed Scopus (140) Google Scholar, 6Cohen P.R. Skin lesions of Sweet's syndrome and its dorsal hand variant contain vasculitis: an oxymoron or an epiphenomenon?.Arch Dermatol. 2002; 138: 400-403Crossref PubMed Google Scholar or involve both the dermis and the subcutaneous fat.4Cohen P.R. Kurzrock R. Sweet's syndrome revisited: a review of disease concepts.Int J Dermatol. 2003; 42: 761-778Crossref PubMed Scopus (336) Google Scholar, 5Cohen P.R. Kurzrock R. Sweet's syndrome: a review of current treatment options.Am J Clin Dermatol. 2002; 3: 117-131Crossref PubMed Scopus (140) Google Scholar, 6Cohen P.R. Skin lesions of Sweet's syndrome and its dorsal hand variant contain vasculitis: an oxymoron or an epiphenomenon?.Arch Dermatol. 2002; 138: 400-403Crossref PubMed Google Scholar, 7Jordaan H.F. Acute febrile neutrphilic dermatosis: a histopathological study of 37 patients and a review of the literature.Am J Dermatopathol. 1989; 11: 99-111Crossref PubMed Scopus (150) Google Scholar, 8Hasegawa M. Sato S. Nakada M. Nitta H. Shirasaki H. Kasahara K. et al.Sweet's syndrome associated with granulocyte colony-stimulating factor.Eur J Dermatol. 1998; 8: 503-505PubMed Google Scholar In addition, the inflammatory infiltrate can be found in either the lobules,1Sutra-Loubet C. Carlotti A. Guillemette J. Wallach D. Neutrophilic panniculitis.J Am Acad Dermatol. 2004; 50: 280-285Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar, 2Cooper P.H. Frierson H.F. Greer K.E. Subcutaneous neutrophilic infiltrates in acute febrile neutrophilic dermatosis.Arch Dermatol. 1983; 119: 610-611Crossref PubMed Scopus (52) Google Scholar, 3Cullity J. Maguire B. Gebauer K. Sweet's panniculitis.Australas J Dermatol. 1991; 32: 61-64Crossref PubMed Scopus (23) Google Scholar, 7Jordaan H.F. Acute febrile neutrphilic dermatosis: a histopathological study of 37 patients and a review of the literature.Am J Dermatopathol. 1989; 11: 99-111Crossref PubMed Scopus (150) Google Scholar the septae,7Jordaan H.F. Acute febrile neutrphilic dermatosis: a histopathological study of 37 patients and a review of the literature.Am J Dermatopathol. 1989; 11: 99-111Crossref PubMed Scopus (150) Google Scholar or both.7Jordaan H.F. Acute febrile neutrphilic dermatosis: a histopathological study of 37 patients and a review of the literature.Am J Dermatopathol. 1989; 11: 99-111Crossref PubMed Scopus (150) Google Scholar, 8Hasegawa M. Sato S. Nakada M. Nitta H. Shirasaki H. Kasahara K. et al.Sweet's syndrome associated with granulocyte colony-stimulating factor.Eur J Dermatol. 1998; 8: 503-505PubMed Google Scholar Therefore, the "clinical entity" of "Sweet's syndrome with subcutaneous involvement" should be included in association with the "localization" heading of not only "hypodermis, septas," but also both "dermis and hypodermis" and "hypodermis, fat lobules" in Table I of Sutra-Loubet et al's paper.1Sutra-Loubet C. Carlotti A. Guillemette J. Wallach D. Neutrophilic panniculitis.J Am Acad Dermatol. 2004; 50: 280-285Abstract Full Text Full Text PDF PubMed Scopus (60) Google ScholarTable IDifferential diagnosis of the lobular subset of neutrophilic panniculitisDiagnosisReferenceAlpha 1-antitrypsin deficiency syndrome9Requena L. Sanchez Yus E. Panniculitis. Part II. Mostly lobular panniculitis.J Am Acad Dermatol. 2001; 45: 325-362Abstract Full Text Full Text PDF PubMed Scopus (436) Google ScholarFactitial∗Secondary to the presence of iatrogenic or self-inflicted foreign bodies.9Requena L. Sanchez Yus E. Panniculitis. Part II. Mostly lobular panniculitis.J Am Acad Dermatol. 2001; 45: 325-362Abstract Full Text Full Text PDF PubMed Scopus (436) Google ScholarInfection†Secondary to either a bacterial, fungal, mycobacterial, or protozoan organism.9Requena L. Sanchez Yus E. Panniculitis. Part II. Mostly lobular panniculitis.J Am Acad Dermatol. 2001; 45: 325-362Abstract Full Text Full Text PDF PubMed Scopus (436) Google ScholarPancreatitis9Requena L. Sanchez Yus E. Panniculitis. Part II. Mostly lobular panniculitis.J Am Acad Dermatol. 2001; 45: 325-362Abstract Full Text Full Text PDF PubMed Scopus (436) Google ScholarRheumatoid arthritis10Tran T.-A.N. DuPree M. Carlson J.A. Neutrophilic lobular (pustular) panniculitis associated with rheumatoid arthritis. A case report and review of the literature.Am J Dermatopathol. 1999; 21: 247-252Crossref PubMed Scopus (38) Google ScholarSubcutaneous Sweet's syndrome1Sutra-Loubet C. Carlotti A. Guillemette J. Wallach D. Neutrophilic panniculitis.J Am Acad Dermatol. 2004; 50: 280-285Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar, 2Cooper P.H. Frierson H.F. Greer K.E. Subcutaneous neutrophilic infiltrates in acute febrile neutrophilic dermatosis.Arch Dermatol. 1983; 119: 610-611Crossref PubMed Scopus (52) Google Scholar, 3Cullity J. Maguire B. Gebauer K. Sweet's panniculitis.Australas J Dermatol. 1991; 32: 61-64Crossref PubMed Scopus (23) Google Scholar, 4Cohen P.R. Kurzrock R. Sweet's syndrome revisited: a review of disease concepts.Int J Dermatol. 2003; 42: 761-778Crossref PubMed Scopus (336) Google Scholar, 7Jordaan H.F. Acute febrile neutrphilic dermatosis: a histopathological study of 37 patients and a review of the literature.Am J Dermatopathol. 1989; 11: 99-111Crossref PubMed Scopus (150) Google Scholar, 8Hasegawa M. Sato S. Nakada M. Nitta H. Shirasaki H. Kasahara K. et al.Sweet's syndrome associated with granulocyte colony-stimulating factor.Eur J Dermatol. 1998; 8: 503-505PubMed Google Scholar∗ Secondary to the presence of iatrogenic or self-inflicted foreign bodies.† Secondary to either a bacterial, fungal, mycobacterial, or protozoan organism. Open table in a new tab Neutrophilic panniculitis and its subset neutrophilic lobular panniculitis are inflammatory processes of mature polymorphonuclear leukocytes that primarily originate within and predominantly involve the lobules of the subcutaneous fat. Secondary extension of the neutrophilic infiltrates may occur into: (1) the septae adjacent to the lobules and (2) the overlying dermis. Hence neutrophilic lobular panniculitis, which represents a category of neutrophilic panniculitis, is merely a descriptive term corresponding to specific pathologic features that can be found in patients who have an underlying, panniculitis-associated etiology (Table I).1Sutra-Loubet C. Carlotti A. Guillemette J. Wallach D. Neutrophilic panniculitis.J Am Acad Dermatol. 2004; 50: 280-285Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar, 2Cooper P.H. Frierson H.F. Greer K.E. Subcutaneous neutrophilic infiltrates in acute febrile neutrophilic dermatosis.Arch Dermatol. 1983; 119: 610-611Crossref PubMed Scopus (52) Google Scholar, 3Cullity J. Maguire B. Gebauer K. Sweet's panniculitis.Australas J Dermatol. 1991; 32: 61-64Crossref PubMed Scopus (23) Google Scholar, 4Cohen P.R. Kurzrock R. Sweet's syndrome revisited: a review of disease concepts.Int J Dermatol. 2003; 42: 761-778Crossref PubMed Scopus (336) Google Scholar, 7Jordaan H.F. Acute febrile neutrphilic dermatosis: a histopathological study of 37 patients and a review of the literature.Am J Dermatopathol. 1989; 11: 99-111Crossref PubMed Scopus (150) Google Scholar, 8Hasegawa M. Sato S. Nakada M. Nitta H. Shirasaki H. Kasahara K. et al.Sweet's syndrome associated with granulocyte colony-stimulating factor.Eur J Dermatol. 1998; 8: 503-505PubMed Google Scholar, 9Requena L. Sanchez Yus E. Panniculitis. Part II. Mostly lobular panniculitis.J Am Acad Dermatol. 2001; 45: 325-362Abstract Full Text Full Text PDF PubMed Scopus (436) Google Scholar, 10Tran T.-A.N. DuPree M. Carlson J.A. Neutrophilic lobular (pustular) panniculitis associated with rheumatoid arthritis. A case report and review of the literature.Am J Dermatopathol. 1999; 21: 247-252Crossref PubMed Scopus (38) Google Scholar Neither neutrophilic panniculitis nor its subset neutrophilic lobular panniculitis are distinct diseases, but a specific pattern of pathologic changes. Indeed, several neutrophilic paniculitis–associated conditions have been described in patients whose clinical lesions have these corresponding microscopic findings. Subcutaneous Sweet's syndrome is one of the conditions that should be included in the histopathologic differential diagnosis of neutrophilic panniculitis.