Case and Research Letter
Sweet's syndrome-like eruption in association with the exacerbation of Behçet's disease after the Great East Japan Earthquake
Erupción tipo síndrome de Sweet asociada al empeoramiento de la enfermdad de Behçet después del Gran terremoto de Japón oriental
Department of Dermatology, Fukushima Medical University, Fukushima, Japan
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In 2011, the patient developed tender, infiltrative erythematous plaques on the forehead and cheeks (b), and erythema nodosum-like lesion on the knee (c).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "T. Miura, M. Ohtsuka, T. Yamamoto" "autores" => array:3 [ 0 => array:2 [ "nombre" => "T." "apellidos" => "Miura" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Ohtsuka" ] 2 => array:2 [ "nombre" => "T." 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A, Newborn: erythematous-violaceous plaques on the back. B, At 6 months of age: plaques with prominent vessels, erythematous borders, and a blue-violaceous center. C, Before laser treatment (7 years of age). D, After 10 sessions of combined pulsed dye and neodymium-doped yttrium aluminium garnet laser treatment (11 years of age).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "N. Vargas-Navia, E. Baselga, F.Z. Muñoz-Garza, L. Puig" "autores" => array:4 [ 0 => array:2 [ "nombre" => "N." "apellidos" => "Vargas-Navia" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Baselga" ] 2 => array:2 [ "nombre" => "F.Z." "apellidos" => "Muñoz-Garza" ] 3 => array:2 [ "nombre" => "L." 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Miura, M. Ohtsuka, T. Yamamoto" "autores" => array:3 [ 0 => array:2 [ "nombre" => "T." "apellidos" => "Miura" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Ohtsuka" ] 2 => array:4 [ "nombre" => "T." "apellidos" => "Yamamoto" "email" => array:1 [ 0 => "toyamade@fmu.ac.jp" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Dermatology, Fukushima Medical University, Fukushima, Japan" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Erupción tipo síndrome de Sweet asociada al empeoramiento de la enfermdad de Behçet después del Gran terremoto de Japón oriental" ] ] "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" => 1524 "Ancho" => 1661 "Tamanyo" => 681410 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histopathology showing dense inflammatory cell infiltrates through the dermis, mainly composed of neutrophils (hematoxylin and eosin stain, original magnification ×40).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We herein report a case of Behçet's disease (BD), which was stable until the Great East Japan Earthquake, but deteriorated thereafter and presented with Sweet's syndrome-like facial erythemas, along with exacerbation of other mucocutaneous conditions.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 36-year-old male visited our hospital, complaining of fever, genital ulcer, folliculitis-like lesions, and erythema nodosum (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>a), and had been diagnosed previously with incomplete type BD six years ago. He received treatment with minocycline, colchicine, and his symptoms were under control. However, his symptoms recurred along with a fever of up to 39<span class="elsevierStyleHsp" style=""></span>°C and throat pain following the Great East Japan Earthquake in March 2011 when he was evacuated from home and placed at a shelter. Physical examination revealed multiple oral ulcers, folliculitis on the back, tender subcutaneous erythematous nodules on the knee, and tender infiltrative erythematous plaques with surface scales on the cheek, forehead, and neck (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>b and c). A biopsy specimen taken from his face showed dense neutrophil infiltration throughout the dermis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Laboratory examination showed elevated levels of white blood cell counts (12,200/μl with 80% neutrophils), C-reactive protein (11.44<span class="elsevierStyleHsp" style=""></span>mg/dl), and erythrocyte sedimentation ratio (41<span class="elsevierStyleHsp" style=""></span>mm/h). Antistreptolysin O (ASO) level was within normal ranges. HLA typing was negative for HLA-B51, but positive for HLA-A2, A24, B54, and B62. He was successfully treated with oral prednisolone (20<span class="elsevierStyleHsp" style=""></span>mg/day).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The present case developed infiltrative erythemas on the face mimicking Sweet's syndrome, along with other cutaneous symptoms such as folliculitis and erythema nodosum. A biopsy specimen from the face revealed dense neutrophil infiltration throughout the dermis. Patients with BD rarely present with Sweet's syndrome-like infiltrative erythema.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> On the other hand, several cases have been reported as a co-existence of BD and Sweet’ syndrome; symptoms of Sweet's syndrome appear representing a flare or in the acute phase of BD.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> BD and Sweet's syndrome share common pathogenesis such as neutrophil activation, and Th1 type cytokines contribute to the pathogenesis of both disorders. We prefer to interpret our case as Sweet's syndrome-like eruptions that developed along with other symptoms such as oral ulcers, folliculitis, and erythema nodosum-like lesions in the exacerbation of BD, rather than the co-existence of Sweet's syndrome with BD, although the criteria of Sweet's syndrome are fulfilled. There were no other apparent triggers such as upper airway or gastrointestinal infections and the use of new drugs for the induction of Sweet's syndrome-like eruptions. Although the frequency is low, BD may be one of the underlying diseases susceptible for developing Sweet's syndrome-like eruptions. We have followed-up the patient for almost 10 years, and although he has had the occasional worsening of BD, the Sweet's syndrome-like eruption occurred only once. Our patient has HLA-B54, which may be an important genetic background in the development of Sweet's syndrome-like eruption.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Psychosocial stress has been reported to be a triggering and worsening factor of BD, and patients frequently develop a neurobehavioural syndrome, defined as ‘neuro-psycho-BD’. Our patient's symptoms were possibly exacerbated by mental stress caused by the Great East Japan Earthquake. Mental health problems have affected many residents of evacuation zones in Fukushima,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> although there are no studies of the deterioration of BD examining a number of patients. Anxiety and depression are common psychiatric disorders in patients with BD and more numerous than in controls,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> and psychological stressors influence the onset and flare of BD and/or recurrent aphthoid stomatitis. Approximately 70% of patients with BD recognized a stress factor prior to the onset of the disease, and 80% of patients with BD declared stress in the relapse period.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a>The hypothalamic-pituitary-adrenal axis affects the immune system, and thus in the present case the stress-induced immune alterations may have worsened the symptoms of BD.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding sources</span><p id="par0030" class="elsevierStylePara elsevierViewall">None.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Funding sources" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1216 "Ancho" => 3000 "Tamanyo" => 394121 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">In 2006, the patient developed solitary scrotum ulcer (a), along with oral ulcers, folliculitis, and erythema nodosum-like lesions. In 2011, the patient developed tender, infiltrative erythematous plaques on the forehead and cheeks (b), and erythema nodosum-like lesion on the knee (c).</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" => 1524 "Ancho" => 1661 "Tamanyo" => 681410 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histopathology showing dense inflammatory cell infiltrates through the dermis, mainly composed of neutrophils (hematoxylin and eosin stain, original magnification ×40).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Behçet's disease with Sweet's syndrome-like presentation: a report of six cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "K.H. Cho" 1 => "K.S. Shin" 2 => "S.J. Sohn" 3 => "S.J. Choi" 4 => "Y.S. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Exp Dermatol" "fecha" => "1989" "volumen" => "14" "paginaInicial" => "20" "paginaFinal" => "24" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2805385" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sweet's syndrome representing a flare of Behçet's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F. Wu" 1 => "X. Luo" 2 => "G. Yuan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Clin Exp Rheumatol" "fecha" => "2009" "volumen" => "27" "numero" => "Suppl." "paginaInicial" => "S88" "paginaFinal" => "S90" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19796541" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Psychological distress after the Great East Japan Earthquake and Fukushima Daiichi Nuclear Power Plant accident: results of a mental health and lifestyle survey through the Fukushima Health Management Survey in FY2011 and FY2012" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Yabe" 1 => "Y. Suzuki" 2 => "H. Mashiko" 3 => "Y. Nakayama" 4 => "M. Hisata" 5 => "S. Niwa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Fukushima J Med Sci" "fecha" => "2014" "volumen" => "60" "paginaInicial" => "57" "paginaFinal" => "67" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25030715" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Depression, anxiety levels and general pshychological profile in Behçet's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. Calikoglu" 1 => "M. Onder" 2 => "B. Cosar" 3 => "S. Candansayar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "51756" "Revista" => array:6 [ "tituloSerie" => "Dermatology" "fecha" => "2001" "volumen" => "203" "paginaInicial" => "238" "paginaFinal" => "240" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11701978" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Stressful life events, anxiety, depression and coping mechanisms in patients with Behçet's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R. Karlidag" 1 => "S. Unal" 2 => "C. Evereklioglu" 3 => "B. Sipahi" 4 => "H. Er" 5 => "S. Yologlu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2003" "volumen" => "17" "paginaInicial" => "670" "paginaFinal" => "675" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14761134" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010800000001/v1_201612300037/S1578219016303353/v1_201612300037/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010800000001/v1_201612300037/S1578219016303353/v1_201612300037/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016303353?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 13 | 10 | 23 |
| 2024 October | 89 | 35 | 124 |
| 2024 September | 112 | 26 | 138 |
| 2024 August | 117 | 51 | 168 |
| 2024 July | 62 | 29 | 91 |
| 2024 June | 64 | 35 | 99 |
| 2024 May | 78 | 28 | 106 |
| 2024 April | 82 | 29 | 111 |
| 2024 March | 76 | 25 | 101 |
| 2024 February | 66 | 35 | 101 |
| 2024 January | 68 | 28 | 96 |
| 2023 December | 57 | 19 | 76 |
| 2023 November | 85 | 30 | 115 |
| 2023 October | 97 | 19 | 116 |
| 2023 September | 55 | 40 | 95 |
| 2023 August | 52 | 17 | 69 |
| 2023 July | 51 | 32 | 83 |
| 2023 June | 66 | 33 | 99 |
| 2023 May | 56 | 31 | 87 |
| 2023 April | 37 | 24 | 61 |
| 2023 March | 41 | 30 | 71 |
| 2023 February | 49 | 25 | 74 |
| 2023 January | 35 | 25 | 60 |
| 2022 December | 48 | 31 | 79 |
| 2022 November | 38 | 23 | 61 |
| 2022 October | 26 | 21 | 47 |
| 2022 September | 48 | 43 | 91 |
| 2022 August | 58 | 35 | 93 |
| 2022 July | 57 | 37 | 94 |
| 2022 June | 28 | 17 | 45 |
| 2022 May | 44 | 26 | 70 |
| 2022 April | 61 | 33 | 94 |
| 2022 March | 60 | 51 | 111 |
| 2022 February | 55 | 36 | 91 |
| 2022 January | 102 | 36 | 138 |
| 2021 December | 60 | 46 | 106 |
| 2021 November | 61 | 52 | 113 |
| 2021 October | 67 | 76 | 143 |
| 2021 September | 44 | 58 | 102 |
| 2021 August | 31 | 45 | 76 |
| 2021 July | 39 | 37 | 76 |
| 2021 June | 26 | 44 | 70 |
| 2021 May | 44 | 62 | 106 |
| 2021 April | 83 | 129 | 212 |
| 2021 March | 57 | 43 | 100 |
| 2021 February | 61 | 32 | 93 |
| 2021 January | 48 | 39 | 87 |
| 2020 December | 33 | 37 | 70 |
| 2020 November | 40 | 14 | 54 |
| 2020 October | 32 | 19 | 51 |
| 2020 September | 36 | 23 | 59 |
| 2020 August | 29 | 21 | 50 |
| 2020 July | 29 | 21 | 50 |
| 2020 June | 29 | 30 | 59 |
| 2020 May | 18 | 10 | 28 |
| 2020 April | 38 | 21 | 59 |
| 2020 March | 20 | 14 | 34 |
| 2020 February | 2 | 0 | 2 |
| 2020 January | 2 | 0 | 2 |
| 2019 December | 8 | 0 | 8 |
| 2019 November | 4 | 0 | 4 |
| 2019 September | 9 | 0 | 9 |
| 2019 August | 4 | 0 | 4 |
| 2019 July | 4 | 0 | 4 |
| 2019 June | 6 | 0 | 6 |
| 2019 May | 6 | 1 | 7 |
| 2019 April | 2 | 4 | 6 |
| 2019 March | 2 | 0 | 2 |
| 2019 February | 2 | 0 | 2 |
| 2019 January | 3 | 0 | 3 |
| 2018 December | 4 | 0 | 4 |
| 2018 November | 3 | 0 | 3 |
| 2018 October | 3 | 0 | 3 |
| 2018 September | 2 | 0 | 2 |
| 2018 February | 26 | 3 | 29 |
| 2018 January | 27 | 7 | 34 |
| 2017 December | 29 | 8 | 37 |
| 2017 November | 27 | 8 | 35 |
| 2017 October | 21 | 9 | 30 |
| 2017 September | 14 | 4 | 18 |
| 2017 August | 24 | 9 | 33 |
| 2017 July | 17 | 8 | 25 |
| 2017 June | 31 | 15 | 46 |
| 2017 May | 24 | 13 | 37 |
| 2017 April | 20 | 12 | 32 |
| 2017 March | 18 | 27 | 45 |
| 2017 February | 45 | 30 | 75 |
| 2017 January | 44 | 34 | 78 |
| 2016 December | 6 | 2 | 8 |
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