[Classical Sweet syndrome with multiple organ lesions by 18F-FDG PET/CT: A case report].

Q3 Medicine
北京大学学报(医学版) Pub Date : 2025-04-18
Zhao Chen, Yongkang Qiu, Lei Kang
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引用次数: 0

Abstract

Sweet syndrome (acute febrile neutrophilic dermatosis) is a relatively rare inflammatory di-sease, which is characterized by the sudden appearance of tender erythematous skin lesions, often accompanied by pyrexia and elevated neutrophil count. The pathogenesis is not clear yet. Recently, multiple studies have found the association between Sweet syndrome and infections, autoimmune diseases, malignant tumors and the application of multiple drugs. According to different causes, Sweet syndrome can be divided into three types: classical (or idiopathic) Sweet syndrome, malignancy-associated Sweet syndrome and drug-induced Sweet syndrome. Classical Sweet syndrome usually presents in women between the age of 30 to 50 years and may be related to infection, inflammatory bowel disease, or pregnancy. The clinical symptoms typically respond promptly after corticosteroid therapy. The major diagnostic criteria of classical Sweet syndrome include sudden painful erythematous skin lesions, histopathologic evidence of a dense neutrophilic infiltrate without evidence of leukocytoclastic vasculitis; minor criteria include pyrexia over 38 ℃, association with hematologic or visceral malignancies, inflammatory diseases, pregnancy or preceded by infection, prompt response to systemic glucocorticoid or potassium iodide treatment, abnormal laboratory values (three of four: erythrocyte sedimentation rate >20 mm/h, positive C-reactive protein, >8.0×109/L leukocytes, >70% neutrophils). The presence of both major criteria and two of the four minor criteria are required to diagnose classical Sweet syndrome. As for the malignancy-associated Sweet syndrome, skin lesions can be found precede, follow, or at the same time with the diagnosis of hematologic malignancy or a solid tumor. At present, 18F-fluorodeoxyglucose (18F-FDG) is commonly used as a positron emission tomography computed tomography (PET/CT) imaging agent for diagnosing and screening malignant tumors. Therefore, most of the case reports on the 18F-FDG PET/CT manifestations of Sweet syndrome are malignancy-associated. Even classical Sweet syndrome is often accompanied by inflammatory bowel disease, autoimmune diseases, etc. Therefore, for patients with suspected or confirmed Sweet syndrome, it is necessary to take 18F-FDG PET/CT examination to clarify the general condition, whether it is for patients with malignant signs such as elevated tumor markers values and weight loss, or for patients with classical Sweet syndrome to exclude underlying inflammatory diseases. 18F-FDG PET/CT is often able to detect the solid tumor early, and assess the degree of hematologic malignancy and inflammatory disease. This study reported a classical Sweet syndrome case associated with inflammatory bowel disease, which was confirmed with skin and intestinal histological examination. The clinical manifestations, laboratory values, 18F-FDG PET/CT manifestations of the patient related diseases were reported, which was to improve nuclear medicine physicians' understanding of Sweet syndrome. Early diagnosis and treatment can often achieve excellent clinical effect.

【18F-FDG PET/CT多脏器病变1例】。
甜综合征(急性发热性中性粒细胞皮肤病)是一种相对罕见的炎症性疾病,其特征是皮肤突然出现柔软的红斑性病变,常伴有发热和中性粒细胞计数升高。发病机制尚不清楚。近年来,多项研究发现Sweet综合征与感染、自身免疫性疾病、恶性肿瘤及多种药物的应用有关。根据成因的不同,可分为经典(或特发性)甜证、恶性相关甜证和药物性甜证三种类型。经典甜综合征通常出现在30至50岁的女性中,可能与感染、炎症性肠病或怀孕有关。临床症状通常在皮质类固醇治疗后迅速反应。经典Sweet综合征的主要诊断标准包括突然疼痛的红斑性皮肤病变,组织病理学证据为密集的中性粒细胞浸润,无白细胞破裂性血管炎的证据;次要标准包括发热超过38℃,与血液学或脏器恶性肿瘤、炎症性疾病、妊娠或感染相关,对全身糖皮质激素或碘化钾治疗的迅速反应,实验室值异常(四项中的三项:红细胞沉降率>20 mm/h, c反应蛋白阳性,>8.0×109/L白细胞,>70%中性粒细胞)。诊断经典Sweet综合征需要两个主要标准和四个次要标准中的两个。对于恶性肿瘤相关的Sweet综合征,可在血液恶性肿瘤或实体瘤诊断之前、之后或同时发现皮肤病变。目前,18f -氟脱氧葡萄糖(18F-FDG)是常用的正电子发射断层计算机断层扫描(PET/CT)显像剂,用于恶性肿瘤的诊断和筛查。因此,Sweet综合征的18F-FDG PET/CT表现多为恶性相关。即使是经典的Sweet综合征,也常常伴有炎症性肠病、自身免疫性疾病等。因此,对于疑似或确诊Sweet综合征的患者,无论是肿瘤标志物值升高、体重下降等恶性征象的患者,还是经典Sweet综合征的患者,均有必要进行18F-FDG PET/CT检查,以明确一般情况。18F-FDG PET/CT通常能够早期发现实体瘤,并评估血液学恶性肿瘤和炎性疾病的程度。本研究报告一例伴有炎性肠病的典型Sweet综合征病例,经皮肤和肠道组织学检查证实。报告患者相关疾病的临床表现、实验室值、18F-FDG PET/CT表现,旨在提高核医学医师对Sweet综合征的认识。早期诊断和治疗往往能取得良好的临床效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
北京大学学报(医学版)
北京大学学报(医学版) Medicine-Medicine (all)
CiteScore
0.80
自引率
0.00%
发文量
9815
期刊介绍: Beijing Da Xue Xue Bao Yi Xue Ban / Journal of Peking University (Health Sciences), established in 1959, is a national academic journal sponsored by Peking University, and its former name is Journal of Beijing Medical University. The coverage of the Journal includes basic medical sciences, clinical medicine, oral medicine, surgery, public health and epidemiology, pharmacology and pharmacy. Over the last few years, the Journal has published articles and reports covering major topics in the different special issues (e.g. research on disease genome, theory of drug withdrawal, mechanism and prevention of cardiovascular and cerebrovascular diseases, stomatology, orthopaedic, public health, urology and reproductive medicine). All the topics involve latest advances in medical sciences, hot topics in specific specialties, and prevention and treatment of major diseases. The Journal has been indexed and abstracted by PubMed Central (PMC), MEDLINE/PubMed, EBSCO, Embase, Scopus, Chemical Abstracts (CA), Western Pacific Region Index Medicus (WPR), JSTChina, and almost all the Chinese sciences and technical index systems, including Chinese Science and Technology Paper Citation Database (CSTPCD), Chinese Science Citation Database (CSCD), China BioMedical Bibliographic Database (CBM), CMCI, Chinese Biological Abstracts, China National Academic Magazine Data-Base (CNKI), Wanfang Data (ChinaInfo), etc.
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