Cases and Research Letters
Neutrophilic Dermatosis on Postmastectomy Lymphedema
Dermatosis neutrofílica sobre área de linfedema posmastectomía
E. Gutiérrez-Paredes
, A. González-Rodríguez, I. Molina-Gallardo, E. Jordá-Cuevas
Corresponding author
Servicio de Dermatología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Spain
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Gutiérrez-Paredes, A. González-Rodríguez, I. Molina-Gallardo, E. Jordá-Cuevas" "autores" => array:4 [ 0 => array:4 [ "nombre" => "E." "apellidos" => "Gutiérrez-Paredes" "email" => array:1 [ 0 => "ev_gutierrez@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "González-Rodríguez" ] 2 => array:2 [ "nombre" => "I." "apellidos" => "Molina-Gallardo" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Jordá-Cuevas" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Dermatología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dermatosis neutrofílica sobre área de linfedema posmastectomía" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 714 "Ancho" => 951 "Tamanyo" => 284191 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Predominantly perivascular and interstitial inflammatory dermal neutrophilic infiltrate.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Classic or idiopathic Sweet syndrome is a neutrophilic skin disorder characterized by the association of cutaneous manifestations and systemic symptoms. The skin lesions tend to occur on the face, neck, chest, and arms, and present as painful papules, nodules, or erythematous plaques. Systemic symptoms, such as general malaise, joint pain, and neutrophilic leukocytosis, may appear days earlier or at the same time as the dermatosis. Classic or idiopathic Sweet syndrome has been linked to digestive and upper airway infections, inflammatory bowel disease, and pregnancy. More rarely, it is induced by drugs (most often granulocyte-colony stimulating factor) or associated with a malignant disease (most commonly hematologic malignancies).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The atypical variant that arises on lymphedema is considered to be a less severe form.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Our patient was a 60-year-old woman who had been diagnosed 6 years previously with invasive ductal carcinoma of the right breast. She underwent conservative surgery with axillary dissection and received radiation therapy and chemotherapy as adjuvant treatment. At the time of consultation, the patient was receiving treatment with capecitabine for liver metastases. Two days earlier, she had developed multiple erythematous maculopapular lesions on the inner aspect of the right upper arm and forearm; the entire arm was edematous and the lesions were very painful to the touch (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Some days before the onset of the cutaneous symptoms, the patient had experienced general malaise, a sensation of poor temperature regulation, and shivers. The only blood test results of interest were elevated C-reactive protein levels (99.6<span class="elsevierStyleHsp" style=""></span>mg/L), and no abnormalities were found in the complete blood count (leukocytes, 7590/mm<span class="elsevierStyleSup">3</span> [neutrophils, 69.9%]). A skin biopsy revealed a dense, neutrophilic inflammatory infiltrate in the dermis, which was predominantly perivascular and interstitial; the epidermis was normal (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). After treatment with amoxicillin–clavulanic acid was initiated, the skin lesions resolved completely in less than a week (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Neutrophilic dermatosis on the site of postmastectomy lymphedema is considered to be an atypical or localized variant of classic or idiopathic Sweet syndrome and only 12 cases have been reported to date (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The disorder has been reported in women aged between 39 and 75 years who have undergone surgery for breast cancer, axillary dissection, and other adjuvant treatments (radiation therapy, hormone therapy, and chemotherapy), and who have developed lymphedema in the ipsilateral arm as a result of those treatments. The interval between breast surgery and appearance of the Sweet skin lesions ranges from a few months to a number of years. Clinically, the disease manifests as multiple painful erythematous papules, which may coalesce to form plaques. The lesions appear on the edematous area, which in most cases comprises the upper arm, forearm, and dorsum of the hand. Less often, the lesions take the form of vesicles or blisters; hemorrhagic blisters or pustules have not been reported. The condition has not been linked to local relapse or distant metastases of the breast cancer, except in 1 case where it was described in association with skin metastases<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>; only 1 case has been reported in a patients receiving granulocyte-colony stimulating factor.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> Compared to classic Sweet syndrome, the systemic symptoms are mild (in some cases absent), neutrophilic leukocytosis is less common, and relapses are less prevalent. The other distinctive difference is that the lesions are restricted to the site of the lymphedema. Treatment with antibiotics appears to cure the lesions more rapidly than treatment with systemic corticosteroids or potassium iodide,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and the disorder also responds well to oral anti-inflammatory drugs and high-potency topical corticosteroids.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–6</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The pathophysiology of this condition is not understood and a number of theories have been put forward, all of which posit a local disruption in cell trafficking due to inadequate lymphatic drainage caused by the lymphadenectomy and the radiation therapy. The hypothesis is that cytokines accumulate at the site of the lymphadenectomy attracting neutrophils to an area with reduced immunocompetence and thereby favoring local development of malignancies, infections, and immune disorders such as neutrophilic dermatosis.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The differential diagnosis should include infections such as cellulitis, erysipelas, folliculitis, and herpes zoster, as well as thrombophlebitis and recall phenomenon. Histology should rule out chronic radiodermatitis, carcinoma erysipeloides, and contact dermatitis. The clinical course, biopsy findings, and additional tests will all help to establish the definitive diagnosis.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In conclusion, we report a new case of neutrophilic dermatosis on the site of a lymphedema. This condition is a localized variant of classic Sweet syndrome with differences that include not only the location of the lesions but also a milder course with fewer systemic symptoms, fewer relapses, and a good response to oral antibiotics, anti-inflammatory drugs, and topical corticosteroids. Despite the large number of cases of breast cancer and of lymphedema arising as a complication of the different treatments used in these patients, few cases of neutrophilic dermatosis have been documented. This is probably due to confusion with other inflammatory or infectious diseases that are more common in this group of patients.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Gutiérrez-Paredes E, González-Rodríguez A, Molina-Gallardo I, Jordá-Cuevas E. Dermatitis neutrofílica sobre área de linfedema posmastectomía. Actas Dermosifiliogr.2012;103:649-651.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1444 "Ancho" => 951 "Tamanyo" => 178627 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Lymphedema and erythematous maculopapular lesions on the inner aspect of the right arm. B) Right arm free of lesions a week after start of treatment.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 714 "Ancho" => 951 "Tamanyo" => 284191 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Predominantly perivascular and interstitial inflammatory dermal neutrophilic infiltrate.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Abbreviations: CT indicates chemotherapy; G-CSF, granulocyte-colony stimulating factor; HT, hormone therapy; RT, Radiation Therapy.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Authors \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Patient Age and Treatments \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Time Elapsed Between Mastectomy and Skin Lesions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Cutaneous Clinical Presentation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Systemic Symptoms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Treatment \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Demitsu et al. (1991)<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39 yRadical mastectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 mo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Erythematous papules and plaques on the upper arm, forearm, and hand \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NoLeukocyte count, 7500/mm<span class="elsevierStyleSup">3</span> (53% neutrophils) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Potassium iodide (900<span class="elsevierStyleHsp" style=""></span>mg/d)Resolution in 3 wk \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71 yRadical mastectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Erythematous plaques on the upper arm and forearm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NoLeukocyte count, 6200/mm<span class="elsevierStyleSup">3</span> (70% neutrophils) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Potassium iodide (900<span class="elsevierStyleHsp" style=""></span>mg/d)Resolution in 3 wk \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Petit et al. (1996)<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48 yMastectomy, RT, CT, HT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not mentioned3 d after G-CSF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Erythematous plaques on the arm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NoLeukocyte count, 7100/mm<span class="elsevierStyleSup">3</span> (4800 neutrophils) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Suspension of G-CSF \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">García-Río et al. (2006)<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67 yRadical mastectomy, RT, CT, tamoxifen \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">132 mo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Erythematous plaques with vesicles on the back, upper arm, forearm, and abdomen \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not mentionedLeukocyte count, 10 600/mm<span class="elsevierStyleSup">3</span> (53% neutrophils) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prednisone and cefuroximeResolution in 20 d \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50 yLumpectomy, RT, tamoxifen \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 mo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Erythematous plaques on the upper arm, forearm, and chest \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not mentionedLeukocyte count, 10 000/mm<span class="elsevierStyleSup">3</span> (83% neutrophils) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No treatmentResolution in 2 mo \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61 yMastectomy, tamoxifen \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 mo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Erythematous plaques on the back, axilla, upper arm, and forearm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not mentionedLeukocyte count, 6300/mm<span class="elsevierStyleSup">3</span> (64.8% neutrophils) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PrednisoneResolution in 10 d \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65 yLumpectomy, RT, tamoxifen \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 mo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Erythematous plaques on the back, upper arm, and forearm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not mentioned \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No treatmentResolution in 2-3 mo \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63 yLumpectomy, RT, CT, tamoxifen \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">168 mo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Erythematous plaques on the back, upper arm, and forearm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not mentionedLeukocyte count, 2036/mm<span class="elsevierStyleSup">3</span> (83.6% neutrophils) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ImipenemResolution in 4-5 d \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55 yLumpectomy, RT, CT, tamoxifen \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34 mo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Erythematous plaques on the back, upper arm, and chest \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FeverLeukocyte count, 6070/mm<span class="elsevierStyleSup">3</span> (54.6% neutrophils) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No treatmentResolution in 4-5 d \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60 yLumpectomy, RT, CT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">132 mo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Erythematous plaques on the upper arm and forearm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not mentionedLeukocyte count, 12 660/mm<span class="elsevierStyleSup">3</span> (91.2% neutrophils) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Amoxicillin–clavulanic acidResolution in 10 d \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lucas et al. (2008)<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75 yMastectomy, RT, CT, tamoxifen \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">More than 5 y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Erythematous papules on the upper arm, forearm, and hand \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NoNot mentioned \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ParacetamolResolution in 7 d \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lee et al. (2009)<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60 yMastectomy, RT, CT, HT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 mo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Erythematous papules with vesicles on the upper arm, forearm, and hand \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NoLeukocyte count, 4070/mm<span class="elsevierStyleSup">3</span> (73.3% neutrophils) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral naproxen and topical clobetasol propionateResolution in 7 d \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab182314.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Reported Cases of Sweet Syndrome Located on the Site of Postmastectomy Lymphedema.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sweet's síndrome revisited: a review of disease concepts" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P.R. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 12 | 10 | 22 |
| 2024 October | 80 | 35 | 115 |
| 2024 September | 87 | 25 | 112 |
| 2024 August | 117 | 51 | 168 |
| 2024 July | 101 | 43 | 144 |
| 2024 June | 114 | 49 | 163 |
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| 2024 April | 88 | 21 | 109 |
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| 2023 October | 79 | 30 | 109 |
| 2023 September | 78 | 33 | 111 |
| 2023 August | 86 | 28 | 114 |
| 2023 July | 84 | 46 | 130 |
| 2023 June | 73 | 27 | 100 |
| 2023 May | 95 | 39 | 134 |
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| 2023 March | 60 | 21 | 81 |
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| 2021 December | 57 | 39 | 96 |
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| 2021 July | 48 | 23 | 71 |
| 2021 June | 29 | 33 | 62 |
| 2021 May | 35 | 39 | 74 |
| 2021 April | 66 | 55 | 121 |
| 2021 March | 58 | 23 | 81 |
| 2021 February | 46 | 20 | 66 |
| 2021 January | 34 | 17 | 51 |
| 2020 December | 30 | 15 | 45 |
| 2020 November | 24 | 16 | 40 |
| 2020 October | 21 | 11 | 32 |
| 2020 September | 33 | 12 | 45 |
| 2020 August | 26 | 15 | 41 |
| 2020 July | 37 | 12 | 49 |
| 2020 June | 35 | 21 | 56 |
| 2020 May | 24 | 14 | 38 |
| 2020 April | 31 | 22 | 53 |
| 2020 March | 29 | 20 | 49 |
| 2020 February | 3 | 0 | 3 |
| 2020 January | 6 | 4 | 10 |
| 2019 December | 8 | 4 | 12 |
| 2019 November | 4 | 1 | 5 |
| 2019 September | 4 | 1 | 5 |
| 2019 August | 4 | 0 | 4 |
| 2019 July | 4 | 7 | 11 |
| 2019 June | 6 | 9 | 15 |
| 2019 May | 4 | 12 | 16 |
| 2019 April | 2 | 5 | 7 |
| 2019 March | 4 | 4 | 8 |
| 2019 January | 4 | 0 | 4 |
| 2018 December | 2 | 0 | 2 |
| 2018 October | 3 | 0 | 3 |
| 2018 September | 3 | 1 | 4 |
| 2018 August | 0 | 5 | 5 |
| 2018 July | 0 | 4 | 4 |
| 2018 May | 0 | 13 | 13 |
| 2018 March | 1 | 0 | 1 |
| 2018 February | 35 | 3 | 38 |
| 2018 January | 47 | 7 | 54 |
| 2017 December | 52 | 10 | 62 |
| 2017 November | 37 | 12 | 49 |
| 2017 October | 23 | 5 | 28 |
| 2017 September | 42 | 13 | 55 |
| 2017 August | 60 | 13 | 73 |
| 2017 July | 45 | 9 | 54 |
| 2017 June | 61 | 33 | 94 |
| 2017 May | 64 | 11 | 75 |
| 2017 April | 62 | 9 | 71 |
| 2017 March | 42 | 29 | 71 |
| 2017 February | 29 | 13 | 42 |
| 2017 January | 35 | 12 | 47 |
| 2016 December | 50 | 27 | 77 |
| 2016 November | 59 | 25 | 84 |
| 2016 October | 55 | 17 | 72 |
| 2016 September | 72 | 7 | 79 |
| 2016 August | 54 | 15 | 69 |
| 2016 July | 42 | 13 | 55 |
| 2016 June | 7 | 8 | 15 |
| 2016 May | 12 | 18 | 30 |
| 2016 April | 6 | 8 | 14 |
| 2016 March | 10 | 9 | 19 |
| 2016 February | 8 | 1 | 9 |
| 2016 January | 7 | 6 | 13 |
| 2015 December | 5 | 8 | 13 |
| 2015 November | 23 | 1 | 24 |
| 2015 October | 18 | 2 | 20 |
| 2015 September | 5 | 3 | 8 |
| 2015 August | 11 | 1 | 12 |
| 2015 July | 63 | 16 | 79 |
| 2015 June | 57 | 35 | 92 |
| 2015 May | 85 | 14 | 99 |
| 2015 April | 76 | 18 | 94 |
| 2015 March | 59 | 9 | 68 |
| 2015 February | 65 | 14 | 79 |
| 2015 January | 46 | 10 | 56 |
| 2014 December | 45 | 10 | 55 |
| 2014 November | 35 | 14 | 49 |
| 2014 October | 59 | 22 | 81 |
| 2014 September | 68 | 13 | 81 |
| 2014 August | 28 | 6 | 34 |
| 2014 July | 30 | 7 | 37 |
| 2014 June | 42 | 11 | 53 |
| 2014 May | 48 | 6 | 54 |
| 2014 April | 43 | 2 | 45 |
| 2014 March | 42 | 11 | 53 |
| 2014 February | 47 | 9 | 56 |
| 2014 January | 37 | 12 | 49 |
| 2013 December | 34 | 5 | 39 |
| 2013 November | 27 | 7 | 34 |
| 2013 October | 16 | 12 | 28 |
| 2013 September | 25 | 13 | 38 |
| 2013 August | 26 | 23 | 49 |
| 2013 July | 16 | 17 | 33 |
| 2013 June | 24 | 32 | 56 |
| 2013 May | 19 | 19 | 38 |
| 2013 April | 13 | 21 | 34 |
| 2013 March | 21 | 6 | 27 |
| 2013 February | 36 | 4 | 40 |
| 2013 January | 56 | 22 | 78 |
| 2012 December | 34 | 15 | 49 |
| 2012 November | 0 | 1 | 1 |
| 2012 October | 0 | 1 | 1 |
| 2012 September | 0 | 2 | 2 |
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