巨大蜂巣炎様スウィート症候群。皮膚および軟部組織の感染症を模倣した、あまり認識されていない臨床的変異型

Giant cellulitis-like Sweet syndrome: An underrecognized clinical variant mimicking skin and soft tissue infection.

• Hayato Mitaka
• Rita Jammal
• Joseph Saabiye
• Stanley Yancovitz
• David C Perlman

抄録

巨大蜂巣炎様Sweet症候群と呼ばれるSweet症候群の新しい臨床的変異型は、患者が大規模な紅斑、発熱、好中球優勢を伴う白血球症の急性発症を呈するため、蜂巣炎と偽ることがある。本症例は、侵襲性乳管癌の既往歴を持つ90歳女性で、3日後に右胸部と右脚部に紅斑を呈した症例である。身体所見では、右胸部と右下肢を中心とした鮮明な紅斑が認められた。臨床検査では好中球性白血球症を認めた．最初に蜂巣炎の臨床診断が下され，セファゾリンの静脈内投与が開始された．発疹は抗生物質で部分的にしか改善しなかった。皮膚生検で好中球浸潤が高密度に認められ，Sweet症候群と一致した．広範囲に認められたプラークから、この症例はSweet症候群の「巨大蜂巣炎様」の変種と考えられた。発熱、好中球肥大、蜂巣炎の非典型的な紅斑を有する患者を評価する際には、臨床医はSweet症候群の疑いを高く持つべきである。

A new clinical variant of Sweet syndrome, called giant cellulitis-like Sweet syndrome, can masquerade as cellulitis because the patients present with an acute onset of large erythematous plaques, fever, and leukocytosis with neutrophil predominance. This case describes a 90-year-old female with a history of invasive ductal carcinoma of the breast who presented with 3 days of erythema of the right chest and right leg. Physical examination was notable for well-demarcated, blanching erythematous rashes involving the right chest and right lower extremity. Laboratory data was notable for neutrophilic leukocytosis. A clinical diagnosis of cellulitis was made initially, and intravenous cefazolin was initiated. The rash had only partially improved with antibiotics. Skin biopsy revealed a dense neutrophilic infiltrate, which was consistent with Sweet syndrome. Based on the widespread plaques, this case was considered a "giant cellulitis-like" variant of Sweet syndrome. Clinicians should have a high index of suspicion for Sweet syndrome when assessing a patient with fever, neutrophilia and erythematous skin plaques atypical of cellulitis because this condition does not respond to antimicrobial therapy and requires systemic glucocorticoid therapy.

© 2020 The Author(s).