CASE REPORT
The Clinical Respiratory Journal
Cryptogenic organizing pneumonia in Sweet’s syndrome: case report and review of the literature Elias Tzelepis1, Christos F. Kampolis1, Ioanna Vlachadami1, Maria Moschovi2, Maria Alamani3 and Gregory Kaltsas1 1 Department of Pathophysiology, ‘Laiko’ Hospital, University of Athens Medical School, Athens, Greece 2 Department of Pediatrics, University of Athens Medical School, Athens, Greece 3 Department of Pathology, Henry Dunant Hospital, Athens, Greece
Abstract Background and Aims: Sweet’s syndrome or acute febrile neutrophilic dermatosis is characterized by fever, leukocytosis and tender erythematous plaques, which show infiltration by mature neutrophils on histological examination. Pulmonary involvement is rare in Sweet’s syndrome. Method: We describe the case of a 17-year-old man with a myelodysplastic syndrome following therapy for Hodgkin’s lymphoma who developed Sweet’s syndrome and cryptogenic organizing pneumonia. In addition, we conducted a review of the related English literature. Results: Literature review yielded six similar reports of biopsy-proven cryptogenic organizing pneumonia associated with Sweet’s syndrome. We present the clinical and laboratory characteristics, as well as the response to treatment, of all cases of cryptogenic organizing pneumonia reported in patients with Sweet’s syndrome. Conclusions: Cryptogenic organizing pneumonia is a rare manifestation of Sweet’s syndrome, which may be complicated by respiratory failure. Prompt treatment with corticosteroids usually leads to clinical and radiographic improvement. Please cite this paper as: Tzelepis E, Kampolis CF, Vlachadami I, Moschovi M, Alamani M and Kaltsas G. Cryptogenic organizing pneumonia in Sweet’s syndrome: case report and review of the literature. Clin Respir J 2014; ••: ••–••. DOI:10.1111/crj.12206.
Conflicts of interest The authors have stated explicitly that there are no conflicts of interest in connection with this article.
Financial sources None.
Introduction Sweet’s syndrome or neutrophilic dermatosis is characterized by fever, peripheral leukocytosis with neutrophilia and cutaneous erythematous plaques, which on biopsy are infiltrated by mature neutrophils. First described by Robert Douglas Sweet in 1964, the syndrome is frequently associated with hematological malignancies, inflammatory diseases, and solid tumors
The Clinical Respiratory Journal (2014) • ISSN 1752-6981 © 2014 John Wiley & Sons Ltd
Key words cryptogenic organizing pneumonia (COP) – myelodysplastic syndrome – neutrophilic dermatosis – Sweet’s syndrome Correspondence Christos F. Kampolis, MD, Department of Pathophysiology, ‘Laiko’ Hospital, University of Athens Medical School, 75 M. Asias Street, 11527 Athens, Greece. Tel: +30 210 746 2649 Fax: +30 210 746 2664 email: [email protected] Received: 19 March 2014 Revision requested: 22 July 2014 Accepted: 27 August 2014 DOI:10.1111/crj.12206 Authorship and contributorship All the authors have substantially contributed to the manuscript. ET, IV, MM and GK took care of patient. ET and CFK conceived the work, searched the English literature and prepared the draft of the manuscript. MA performed microscopic examination of biopsy samples and created the related images. GK, MM and IV critically revised the manuscript. Ethics This article was created in accordance with the ethical standards of the Declaration of Helsinki (2000).
or is of idiopathic nature. Although extracutaneous manifestations, such as joint and ocular involvement, may frequently occur, respiratory failure related to cryptogenic organizing pneumonia (COP) is rare. In this report, we describe a case of Sweet’s syndrome that manifested with severe respiratory failure due to COP. In addition, we report the clinical and laboratory characteristics of all cases of Sweet’s syndromeassociated COP reported in the English literature.
1
COP and Sweet’s syndrome
Tzelepis et al.
Case report A 17-year-old male patient presented with a 3-day history of fever to 39°C, acute dyspnea and a skin rash on his right upper arm. The patient has history of Hodgkin’s lymphoma (stage IV), diagnosed 8 years ago, for which he was treated with chemotherapy, radiation therapy and splenectomy. The patient had received his last chemotherapy regimen (six cycles of mustargen, oncovin, procarbazine, prednisone/adriamycin, bleomycin, vinblastine, dacarbazine and nine cycles of bleomycin, etoposide, adriamycin, cyclophosphamide, oncovin, procarbazine and prednisone) 4 years prior to admission to our hospital. Over the last 4 years prior to hospitalization, he was intermittently treated with antibiotics for respiratory tract infections. A bone marrow biopsy had revealed evidence of myelodysplastic syndrome (MDS) related to his previous treatment but no evidence of recurrence of Hodgkin’s disease. Approximately 8 months prior to this admission, the patient was hospitalized at another hospital with a similar lower extremity rash, which on biopsy was compatible with pyoderma gangrenosum. Three weeks after the onset of skin rash, he developed bilateral pulmonary infiltrates. Despite treatment with antibiotics, the pulmonary infiltrates progressed; the patient developed respiratory failure and was treated in the intensive care unit (ICU) for 3 weeks. Following initiation of empirical treatment with corticosteroids for possible COP, the infiltrates resolved radiographically, and the patient improved and was discharged home. An initial dose of 1 mg/kg prednisone was given orally for the first 6 weeks, which was gradually tapered at monthly intervals until complete cessation 6 months later. Over the 3-week period prior to current admission, he had not received any treatment (including steroids). A week prior to admission, the patient developed low-grade fever (140 – – CRP >370
Improvement Improvement Relapse Improvement Relapse Improvement Relapse/death
M, male; F, female; MDS, myelodysplastic syndrome; U, unilaterally; B, bilaterally; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; m, month.
Generally, lung involvement is considered a rare extracutaneous manifestation of Sweet’s syndrome. In most reported cases, the syndrome was associated with an underlying hematological disorder. Skin and pulmonary lesions are usually concomitant, but in some cases skin lesions appear months or years before pulmonary involvement (3–6). Sweet’s syndrome presenting with pulmonary involvement before appearance of skin lesions is extremely rare (7, 8). Patients with lung involvement typically complain of dyspnea, cough, fever and general malaise. Extensive lung involvement may lead to respiratory failure, often requiring admission to the ICU and mechanical ventilation (7, 9). Radiological studies with chest radiographs or computed tomography reveal unilateral or bilateral interstitial infiltrates, and single or multiple opacities. Occasionally, pleural effusions precede or occur simultaneously with lung opacities (10, 11). The histopathological changes described in patients with pulmonary involvement are of two types, one of a diffuse pulmonary inflammation similar to that described in skin, and one of COP. The former is characterized by a variable picture consisting of interstitial pneumonia with numerous infiltrating polymorphonuclear cells, alveolar macrophages and less often eosinophils, or small lymphocytes. In some reports, there was evidence of intra-alveolar edema and minimal fibrosis (9, 12–14). Typical histopathology of COP has been reported in combination with diffuse interstitial changes or as the sole pathological findings (8, 15–19). COP confirmed by lung biopsy has been described in only few reports in the literature. It is likely, however, that COP is more frequent as cases with clinical and radiological characteristics typical of COP in the setting of Sweet’s syndrome are usually treated with steroids and not confirmed by lung biopsy (14, 16). Clinical and laboratory characteristics of all reported COP biopsy-proven cases are shown in Table 1. The most common underlying disease (seen
4
in three out of seven cases) was MDS, whereas no case was associated with a solid malignancy. Pulmonary manifestations followed skin findings in four cases, preceded skin rash in two cases, whereas both lung and skin manifestations appeared concomitantly in the remaining case. Elevated indices of inflammation (such as ESR >100, or CRP) or peripheral leukocytosis were reported in most cases. Although two patients had severe hypoxemia, none required mechanical ventilation. Treatment with steroids led to a prompt clinical improvement, with normalization of inflammatory markers usually within a week. Relapse of pulmonary symptoms with reappearance of infiltrates was noted in three cases, typically during steroid tapering. Our case report highlights the importance of considering COP in the differential diagnosis of pulmonary infiltrates in patients with Sweet’s syndrome. Persistent pulmonary opacities not responding to antibiotic therapy in conjunction with marked elevation of the inflammatory indices should raise suspicion for COP. Treatment includes corticosteroids plus treatment of the underlying hematological or other disorder that is associated with Sweet’s syndrome. Although COP is typically corticosteroid-responsive, more than 50% of treated patients relapse after initial treatment (20). In conclusion, COP may complicate Sweet’s syndrome and lead to respiratory failure. It should be suspected in patients with the characteristic skin manifestations of Sweet’s syndrome and progressing pulmonary opacities. Prompt diagnosis and treatment with steroids usually lead to clinical improvement and resolution of pulmonary infiltrates.
References 1. Von den Driesch P, Gomez RS, Kiesewetter F, Hornstein OP. Sweet’s syndrome: clinical spectrum and associated conditions. Cutis. 1989;44: 193–200.
The Clinical Respiratory Journal (2014) • ISSN 1752-6981 © 2014 John Wiley & Sons Ltd
Tzelepis et al.
2. Cohen PR, Talpaz M, Kurzrock R. Malignancy-associated Sweet’s syndrome: review of the world literature. J Clin Oncol. 1988;6: 1887–97. 3. Rodot S, Lacour JP, Van Elslande L, Cognard C, Castanet J, Ortonne JP. [Extracutaneous manifestations of neutrophilic dermatosis]. Ann Dermatol Vénéréologie. 1996;123: 129–34. 4. Hatch ME, Farber SS, Superfon NP, Ligorsky RD, Williams HE. Sweet’s syndrome associated with chronic myelogenous leukemia. J Am Osteopath Assoc. 1989;89: 363–70. 5. Thurnheer R, Stammberger U, Hailemariam S, Russi EW. Bronchial manifestation of acute febrile neutrophilic dermatosis (Sweet’s syndrome). Eur Respir J. 1998;11: 978–80. 6. Imanaga T, Hayashi T, Yoshii C, Suzuki S, Yatera K, Kido M. [Pulmonary involvement in acute febrile neutrophilic dermatosis (Sweet’s syndrome)]. Nihon Kokyu¯ki Gakkai Zasshi. 2000;38: 206–10. 7. Petrig C, Bassetti S, Passweg J, Marsch S. Acute respiratory failure due to sweet syndrome. Am J Med Sci. 2006;331: 159–61. 8. Reid PT, Alderdice J, Carson J, Sinnamon DG. Cryptogenic organizing pneumonia in association with Sweet’s syndrome. Respir Med. 1996;90: 57–9. 9. Takimoto CH, Warnock M, Golden JA. Sweet’s syndrome with lung involvement. Am Rev Respir Dis. 1991;143: 177–9. 10. Fett DL, Gibson LE, Su WP. Sweet’s syndrome: systemic signs and symptoms and associated disorders. Mayo Clin Proc. 1995;70: 234–40. 11. Peters FP, Drent M, Verhaegh M, van Pampus EC, Schouten HC. Myelodysplasia presenting with pulmonary manifestations associated with neutrophilic dermatosis. Ann Hematol. 1998;77: 135–8. 12. Lazarus AA, McMillan M, Miramadi A. Pulmonary involvement in Sweet’s syndrome (acute febrile
The Clinical Respiratory Journal (2014) • ISSN 1752-6981 © 2014 John Wiley & Sons Ltd
COP and Sweet’s syndrome
13.
14.
15.
16.
17.
18.
19.
20.
neutrophilic dermatosis). Preleukemic and leukemic phases of acute myelogenous leukemia. Chest. 1986;90: 922–4. Astudillo L, Sailler L, Launay F, Josse AG, Lamant L, Couret B, Arlet-Suau E. Pulmonary involvement in Sweet’s syndrome: a case report and review of the literature. Int J Dermatol. 2006;45: 677–80. Gibson LE, Dicken CH, Flach DB. Neutrophilic dermatoses and myeloproliferative disease: report of two cases. Mayo Clin Proc. 1985;60: 735–40. Chien SM, Jambrosic J, Mintz S. Pulmonary manifestations in Sweet’s syndrome: first report of a case with bronchiolitis obliterans organizing pneumonia. Am J Med. 1991;91: 553–4. Longo MI, Pico M, Bueno C, Lázaro P, Serrano J, Lecona M, Carretero L, Alvarez E. Sweet’s syndrome and bronchiolitis obliterans organizing pneumonia. Am J Med. 2001;111: 80–1. Garg R, Soud Y, Lal R, Mehta N, Kone BC. Myelodysplastic syndrome manifesting as Sweet’s Syndrome and bronchiolitis obliterative organizing pneumonia. Am J Med. 2006;119: e5–7. Karamlou K, Gorn AH. Refractory sweet syndrome with autoimmune organizing pneumonia treated with monoclonal antibodies to tumor necrosis factor. J Clin Rheumatol. 2004;10: 331–5. Chatham-Stephens K, Devere T, Guzman-Cottrill J, Kurre P. Metachronous manifestations of Sweet’s syndrome in a neutropenic patient with Fanconi anemia. Pediatr Blood Cancer. 2008;51: 128–30. Lazor R, Vandevenne A, Pelletier A, Leclerc P, Court-Fortune I, Cordier JF. Cryptogenic organizing pneumonia. Characteristics of relapses in a series of 48 patients. The Groupe d’Etudes et de Recherche sur les Maladles ‘Orphelines’ Pulmonaires (GERM‘O’P). Am J Respir Crit Care Med. 2000; 162: 571–7.
5
The Clinical Respiratory Journal
Cryptogenic organizing pneumonia in Sweet’s syndrome: case report and review of the literature Elias Tzelepis1, Christos F. Kampolis1, Ioanna Vlachadami1, Maria Moschovi2, Maria Alamani3 and Gregory Kaltsas1 1 Department of Pathophysiology, ‘Laiko’ Hospital, University of Athens Medical School, Athens, Greece 2 Department of Pediatrics, University of Athens Medical School, Athens, Greece 3 Department of Pathology, Henry Dunant Hospital, Athens, Greece
Abstract Background and Aims: Sweet’s syndrome or acute febrile neutrophilic dermatosis is characterized by fever, leukocytosis and tender erythematous plaques, which show infiltration by mature neutrophils on histological examination. Pulmonary involvement is rare in Sweet’s syndrome. Method: We describe the case of a 17-year-old man with a myelodysplastic syndrome following therapy for Hodgkin’s lymphoma who developed Sweet’s syndrome and cryptogenic organizing pneumonia. In addition, we conducted a review of the related English literature. Results: Literature review yielded six similar reports of biopsy-proven cryptogenic organizing pneumonia associated with Sweet’s syndrome. We present the clinical and laboratory characteristics, as well as the response to treatment, of all cases of cryptogenic organizing pneumonia reported in patients with Sweet’s syndrome. Conclusions: Cryptogenic organizing pneumonia is a rare manifestation of Sweet’s syndrome, which may be complicated by respiratory failure. Prompt treatment with corticosteroids usually leads to clinical and radiographic improvement. Please cite this paper as: Tzelepis E, Kampolis CF, Vlachadami I, Moschovi M, Alamani M and Kaltsas G. Cryptogenic organizing pneumonia in Sweet’s syndrome: case report and review of the literature. Clin Respir J 2014; ••: ••–••. DOI:10.1111/crj.12206.
Conflicts of interest The authors have stated explicitly that there are no conflicts of interest in connection with this article.
Financial sources None.
Introduction Sweet’s syndrome or neutrophilic dermatosis is characterized by fever, peripheral leukocytosis with neutrophilia and cutaneous erythematous plaques, which on biopsy are infiltrated by mature neutrophils. First described by Robert Douglas Sweet in 1964, the syndrome is frequently associated with hematological malignancies, inflammatory diseases, and solid tumors
The Clinical Respiratory Journal (2014) • ISSN 1752-6981 © 2014 John Wiley & Sons Ltd
Key words cryptogenic organizing pneumonia (COP) – myelodysplastic syndrome – neutrophilic dermatosis – Sweet’s syndrome Correspondence Christos F. Kampolis, MD, Department of Pathophysiology, ‘Laiko’ Hospital, University of Athens Medical School, 75 M. Asias Street, 11527 Athens, Greece. Tel: +30 210 746 2649 Fax: +30 210 746 2664 email: [email protected] Received: 19 March 2014 Revision requested: 22 July 2014 Accepted: 27 August 2014 DOI:10.1111/crj.12206 Authorship and contributorship All the authors have substantially contributed to the manuscript. ET, IV, MM and GK took care of patient. ET and CFK conceived the work, searched the English literature and prepared the draft of the manuscript. MA performed microscopic examination of biopsy samples and created the related images. GK, MM and IV critically revised the manuscript. Ethics This article was created in accordance with the ethical standards of the Declaration of Helsinki (2000).
or is of idiopathic nature. Although extracutaneous manifestations, such as joint and ocular involvement, may frequently occur, respiratory failure related to cryptogenic organizing pneumonia (COP) is rare. In this report, we describe a case of Sweet’s syndrome that manifested with severe respiratory failure due to COP. In addition, we report the clinical and laboratory characteristics of all cases of Sweet’s syndromeassociated COP reported in the English literature.
1
COP and Sweet’s syndrome
Tzelepis et al.
Case report A 17-year-old male patient presented with a 3-day history of fever to 39°C, acute dyspnea and a skin rash on his right upper arm. The patient has history of Hodgkin’s lymphoma (stage IV), diagnosed 8 years ago, for which he was treated with chemotherapy, radiation therapy and splenectomy. The patient had received his last chemotherapy regimen (six cycles of mustargen, oncovin, procarbazine, prednisone/adriamycin, bleomycin, vinblastine, dacarbazine and nine cycles of bleomycin, etoposide, adriamycin, cyclophosphamide, oncovin, procarbazine and prednisone) 4 years prior to admission to our hospital. Over the last 4 years prior to hospitalization, he was intermittently treated with antibiotics for respiratory tract infections. A bone marrow biopsy had revealed evidence of myelodysplastic syndrome (MDS) related to his previous treatment but no evidence of recurrence of Hodgkin’s disease. Approximately 8 months prior to this admission, the patient was hospitalized at another hospital with a similar lower extremity rash, which on biopsy was compatible with pyoderma gangrenosum. Three weeks after the onset of skin rash, he developed bilateral pulmonary infiltrates. Despite treatment with antibiotics, the pulmonary infiltrates progressed; the patient developed respiratory failure and was treated in the intensive care unit (ICU) for 3 weeks. Following initiation of empirical treatment with corticosteroids for possible COP, the infiltrates resolved radiographically, and the patient improved and was discharged home. An initial dose of 1 mg/kg prednisone was given orally for the first 6 weeks, which was gradually tapered at monthly intervals until complete cessation 6 months later. Over the 3-week period prior to current admission, he had not received any treatment (including steroids). A week prior to admission, the patient developed low-grade fever (140 – – CRP >370
Improvement Improvement Relapse Improvement Relapse Improvement Relapse/death
M, male; F, female; MDS, myelodysplastic syndrome; U, unilaterally; B, bilaterally; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; m, month.
Generally, lung involvement is considered a rare extracutaneous manifestation of Sweet’s syndrome. In most reported cases, the syndrome was associated with an underlying hematological disorder. Skin and pulmonary lesions are usually concomitant, but in some cases skin lesions appear months or years before pulmonary involvement (3–6). Sweet’s syndrome presenting with pulmonary involvement before appearance of skin lesions is extremely rare (7, 8). Patients with lung involvement typically complain of dyspnea, cough, fever and general malaise. Extensive lung involvement may lead to respiratory failure, often requiring admission to the ICU and mechanical ventilation (7, 9). Radiological studies with chest radiographs or computed tomography reveal unilateral or bilateral interstitial infiltrates, and single or multiple opacities. Occasionally, pleural effusions precede or occur simultaneously with lung opacities (10, 11). The histopathological changes described in patients with pulmonary involvement are of two types, one of a diffuse pulmonary inflammation similar to that described in skin, and one of COP. The former is characterized by a variable picture consisting of interstitial pneumonia with numerous infiltrating polymorphonuclear cells, alveolar macrophages and less often eosinophils, or small lymphocytes. In some reports, there was evidence of intra-alveolar edema and minimal fibrosis (9, 12–14). Typical histopathology of COP has been reported in combination with diffuse interstitial changes or as the sole pathological findings (8, 15–19). COP confirmed by lung biopsy has been described in only few reports in the literature. It is likely, however, that COP is more frequent as cases with clinical and radiological characteristics typical of COP in the setting of Sweet’s syndrome are usually treated with steroids and not confirmed by lung biopsy (14, 16). Clinical and laboratory characteristics of all reported COP biopsy-proven cases are shown in Table 1. The most common underlying disease (seen
4
in three out of seven cases) was MDS, whereas no case was associated with a solid malignancy. Pulmonary manifestations followed skin findings in four cases, preceded skin rash in two cases, whereas both lung and skin manifestations appeared concomitantly in the remaining case. Elevated indices of inflammation (such as ESR >100, or CRP) or peripheral leukocytosis were reported in most cases. Although two patients had severe hypoxemia, none required mechanical ventilation. Treatment with steroids led to a prompt clinical improvement, with normalization of inflammatory markers usually within a week. Relapse of pulmonary symptoms with reappearance of infiltrates was noted in three cases, typically during steroid tapering. Our case report highlights the importance of considering COP in the differential diagnosis of pulmonary infiltrates in patients with Sweet’s syndrome. Persistent pulmonary opacities not responding to antibiotic therapy in conjunction with marked elevation of the inflammatory indices should raise suspicion for COP. Treatment includes corticosteroids plus treatment of the underlying hematological or other disorder that is associated with Sweet’s syndrome. Although COP is typically corticosteroid-responsive, more than 50% of treated patients relapse after initial treatment (20). In conclusion, COP may complicate Sweet’s syndrome and lead to respiratory failure. It should be suspected in patients with the characteristic skin manifestations of Sweet’s syndrome and progressing pulmonary opacities. Prompt diagnosis and treatment with steroids usually lead to clinical improvement and resolution of pulmonary infiltrates.
References 1. Von den Driesch P, Gomez RS, Kiesewetter F, Hornstein OP. Sweet’s syndrome: clinical spectrum and associated conditions. Cutis. 1989;44: 193–200.
The Clinical Respiratory Journal (2014) • ISSN 1752-6981 © 2014 John Wiley & Sons Ltd
Tzelepis et al.
2. Cohen PR, Talpaz M, Kurzrock R. Malignancy-associated Sweet’s syndrome: review of the world literature. J Clin Oncol. 1988;6: 1887–97. 3. Rodot S, Lacour JP, Van Elslande L, Cognard C, Castanet J, Ortonne JP. [Extracutaneous manifestations of neutrophilic dermatosis]. Ann Dermatol Vénéréologie. 1996;123: 129–34. 4. Hatch ME, Farber SS, Superfon NP, Ligorsky RD, Williams HE. Sweet’s syndrome associated with chronic myelogenous leukemia. J Am Osteopath Assoc. 1989;89: 363–70. 5. Thurnheer R, Stammberger U, Hailemariam S, Russi EW. Bronchial manifestation of acute febrile neutrophilic dermatosis (Sweet’s syndrome). Eur Respir J. 1998;11: 978–80. 6. Imanaga T, Hayashi T, Yoshii C, Suzuki S, Yatera K, Kido M. [Pulmonary involvement in acute febrile neutrophilic dermatosis (Sweet’s syndrome)]. Nihon Kokyu¯ki Gakkai Zasshi. 2000;38: 206–10. 7. Petrig C, Bassetti S, Passweg J, Marsch S. Acute respiratory failure due to sweet syndrome. Am J Med Sci. 2006;331: 159–61. 8. Reid PT, Alderdice J, Carson J, Sinnamon DG. Cryptogenic organizing pneumonia in association with Sweet’s syndrome. Respir Med. 1996;90: 57–9. 9. Takimoto CH, Warnock M, Golden JA. Sweet’s syndrome with lung involvement. Am Rev Respir Dis. 1991;143: 177–9. 10. Fett DL, Gibson LE, Su WP. Sweet’s syndrome: systemic signs and symptoms and associated disorders. Mayo Clin Proc. 1995;70: 234–40. 11. Peters FP, Drent M, Verhaegh M, van Pampus EC, Schouten HC. Myelodysplasia presenting with pulmonary manifestations associated with neutrophilic dermatosis. Ann Hematol. 1998;77: 135–8. 12. Lazarus AA, McMillan M, Miramadi A. Pulmonary involvement in Sweet’s syndrome (acute febrile
The Clinical Respiratory Journal (2014) • ISSN 1752-6981 © 2014 John Wiley & Sons Ltd
COP and Sweet’s syndrome
13.
14.
15.
16.
17.
18.
19.
20.
neutrophilic dermatosis). Preleukemic and leukemic phases of acute myelogenous leukemia. Chest. 1986;90: 922–4. Astudillo L, Sailler L, Launay F, Josse AG, Lamant L, Couret B, Arlet-Suau E. Pulmonary involvement in Sweet’s syndrome: a case report and review of the literature. Int J Dermatol. 2006;45: 677–80. Gibson LE, Dicken CH, Flach DB. Neutrophilic dermatoses and myeloproliferative disease: report of two cases. Mayo Clin Proc. 1985;60: 735–40. Chien SM, Jambrosic J, Mintz S. Pulmonary manifestations in Sweet’s syndrome: first report of a case with bronchiolitis obliterans organizing pneumonia. Am J Med. 1991;91: 553–4. Longo MI, Pico M, Bueno C, Lázaro P, Serrano J, Lecona M, Carretero L, Alvarez E. Sweet’s syndrome and bronchiolitis obliterans organizing pneumonia. Am J Med. 2001;111: 80–1. Garg R, Soud Y, Lal R, Mehta N, Kone BC. Myelodysplastic syndrome manifesting as Sweet’s Syndrome and bronchiolitis obliterative organizing pneumonia. Am J Med. 2006;119: e5–7. Karamlou K, Gorn AH. Refractory sweet syndrome with autoimmune organizing pneumonia treated with monoclonal antibodies to tumor necrosis factor. J Clin Rheumatol. 2004;10: 331–5. Chatham-Stephens K, Devere T, Guzman-Cottrill J, Kurre P. Metachronous manifestations of Sweet’s syndrome in a neutropenic patient with Fanconi anemia. Pediatr Blood Cancer. 2008;51: 128–30. Lazor R, Vandevenne A, Pelletier A, Leclerc P, Court-Fortune I, Cordier JF. Cryptogenic organizing pneumonia. Characteristics of relapses in a series of 48 patients. The Groupe d’Etudes et de Recherche sur les Maladles ‘Orphelines’ Pulmonaires (GERM‘O’P). Am J Respir Crit Care Med. 2000; 162: 571–7.
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