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Case Reports
. 2021 Mar 16:36:100749.
doi: 10.1016/j.gore.2021.100749. eCollection 2021 May.

Sweet syndrome with bitter outcomes in cervical cancer: A case report

Lamiman Kelly  1 , Sheu Justine  1 , Goodwin Brandon  2 , Hatch Sandra  3   4 , Richardson Gwyn  1   5
Affiliations
Case Reports

Sweet syndrome with bitter outcomes in cervical cancer: A case report

Lamiman Kelly et al. Gynecol Oncol Rep. .

Abstract

Background: Sweet Syndrome, or acute febrile neutrophilic dermatosis, is a non-infectious, painful rash accompanied by fever, leukocytosis and skin biopsy showing neutrophilic dermal inflammation. It is either idiopathic, drug-induced or malignancy associated (MASS). MASS is uncommon in cervical cancer, and usually signals diagnosis, progression or recurrence.

Clinical course: Two months following chemoradiation for stage IIIC2(r) squamous cell carcinoma (SCC) of the cervix, a 55-year-old female developed painful papules and plaques on her left toes. One week later she developed fever and the rash spread to her body. Labs revealed leukopenia and an elevated erythrocyte sedimentation rate. Punch biopsy showed neutrophilic dermal inflammation with papillary dermal edema and was negative for infectious immunohistochemistry. The clinical presentation and histopathological features were consistent with, and met diagnostic criteria for Sweet Syndrome. One month following Sweet Syndrome diagnosis and four months following chemoradiation, positron emission tomography scan revealed recurrence in the pelvic lymph nodes. At this time, she had residual rash on her thighs that responded to oral methylprednisolone. She declined further chemotherapy for recurrent SCC and opted for palliative care.

Conclusion: We present a rare case of MASS in cervical cancer associated with recurrence two months after chemoradiation.

Keywords: Acute febrile neutrophilic dermatosis; Cancer surveillance; Cervical cancer; Metastasis; Recurrence; Sweet syndrome.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
A). MRI at diagnosis showing a 5.6 × 3.7 cm cervical mass with extension into the lower uterine segment, bilateral parametrial involvement, right obturator node measuring 2.0 cm and right internal iliac node measuring 0.7 cm. B). PET at diagnosis showing FDG avidity in the cervix (SUV 33.4), right external iliac nodal conglomerate (3.1 × 1.7 cm, SUV 25.5), right iliac chain node (SUV 3.44), right infrarenal para-aortic node (SUV 3.99) and left external iliac node (SUV 2.88). C). MRI obtained for brachytherapy planning after chemotherapy and EBRT showed treatment response with no definitive tumor seen, and no lymphadenopathy. D). Three weeks after Sweet Syndrome diagnosis, PET scan showed resolution at the cervix (SUV 1.9) but high metabolic activity in the right pelvic sidewall (2.3 × 1.5 cm, SUV 15.3), and new areas of avidity in the left common iliac node (1.4 × 1.2 cm, SUV 15.5) and left distal internal iliac node (1.6 × 1.2 cm, SUV 19.0).
Fig. 2
Fig. 2
Rash on admission for workup showing involvement of all four extremities and the trunk, sparing only the face, soles and right palm.
Fig. 3
Fig. 3
Histopathology of skin punch biopsies obtained from left leg and back. A). Low Power (40×) and B). Medium power (100×) microscopic images: Superficial nodular dermal predominately neutrophilic infiltrate with mild papillary dermal edema C). High Power 600x microscopic images: Chiefly neutrophilic dermal inflammation with associated leukocytoclasia and accompanying lymphohistiocytic inflammation.
See this image and copyright information in PMC

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