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
T. Miura, M. Ohtsuka, T. Yamamoto
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Department of Dermatology, Fukushima Medical University, Fukushima, Japan
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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" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 729 "Ancho" => 1800 "Tamanyo" => 209306 ] ] "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>" ] ] ] "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" => 729 "Ancho" => 1800 "Tamanyo" => 209306 ] ] "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" => 981 "Ancho" => 1068 "Tamanyo" => 336047 ] ] "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. 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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. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 8 | 10 | 18 |
| 2024 Octubre | 75 | 33 | 108 |
| 2024 Septiembre | 78 | 17 | 95 |
| 2024 Agosto | 106 | 46 | 152 |
| 2024 Julio | 109 | 24 | 133 |
| 2024 Junio | 91 | 47 | 138 |
| 2024 Mayo | 55 | 26 | 81 |
| 2024 Abril | 79 | 38 | 117 |
| 2024 Marzo | 68 | 25 | 93 |
| 2024 Febrero | 55 | 24 | 79 |
| 2024 Enero | 79 | 34 | 113 |
| 2023 Diciembre | 56 | 16 | 72 |
| 2023 Noviembre | 80 | 33 | 113 |
| 2023 Octubre | 76 | 34 | 110 |
| 2023 Septiembre | 86 | 30 | 116 |
| 2023 Agosto | 69 | 14 | 83 |
| 2023 Julio | 114 | 27 | 141 |
| 2023 Junio | 63 | 22 | 85 |
| 2023 Mayo | 77 | 18 | 95 |
| 2023 Abril | 75 | 15 | 90 |
| 2023 Marzo | 77 | 25 | 102 |
| 2023 Febrero | 65 | 19 | 84 |
| 2023 Enero | 50 | 23 | 73 |
| 2022 Diciembre | 76 | 34 | 110 |
| 2022 Noviembre | 60 | 31 | 91 |
| 2022 Octubre | 80 | 30 | 110 |
| 2022 Septiembre | 46 | 42 | 88 |
| 2022 Agosto | 59 | 50 | 109 |
| 2022 Julio | 67 | 44 | 111 |
| 2022 Junio | 69 | 33 | 102 |
| 2022 Mayo | 87 | 38 | 125 |
| 2022 Abril | 89 | 36 | 125 |
| 2022 Marzo | 59 | 58 | 117 |
| 2022 Febrero | 62 | 28 | 90 |
| 2022 Enero | 116 | 45 | 161 |
| 2021 Diciembre | 84 | 42 | 126 |
| 2021 Noviembre | 76 | 46 | 122 |
| 2021 Octubre | 67 | 58 | 125 |
| 2021 Septiembre | 54 | 42 | 96 |
| 2021 Agosto | 53 | 39 | 92 |
| 2021 Julio | 40 | 39 | 79 |
| 2021 Junio | 36 | 32 | 68 |
| 2021 Mayo | 47 | 37 | 84 |
| 2021 Abril | 77 | 48 | 125 |
| 2021 Marzo | 76 | 38 | 114 |
| 2021 Febrero | 62 | 32 | 94 |
| 2021 Enero | 39 | 22 | 61 |
| 2020 Diciembre | 51 | 21 | 72 |
| 2020 Noviembre | 32 | 17 | 49 |
| 2020 Octubre | 36 | 20 | 56 |
| 2020 Septiembre | 37 | 15 | 52 |
| 2020 Agosto | 28 | 14 | 42 |
| 2020 Julio | 34 | 13 | 47 |
| 2020 Junio | 46 | 35 | 81 |
| 2020 Mayo | 22 | 11 | 33 |
| 2020 Abril | 42 | 22 | 64 |
| 2020 Marzo | 26 | 22 | 48 |
| 2020 Febrero | 6 | 2 | 8 |
| 2019 Diciembre | 4 | 0 | 4 |
| 2019 Septiembre | 6 | 0 | 6 |
| 2019 Julio | 7 | 0 | 7 |
| 2019 Mayo | 3 | 0 | 3 |
| 2019 Abril | 0 | 4 | 4 |
| 2019 Marzo | 1 | 0 | 1 |
| 2019 Febrero | 3 | 0 | 3 |
| 2019 Enero | 1 | 0 | 1 |
| 2018 Noviembre | 2 | 0 | 2 |
| 2018 Octubre | 1 | 0 | 1 |
| 2018 Septiembre | 1 | 0 | 1 |
| 2018 Julio | 1 | 0 | 1 |
| 2018 Junio | 0 | 1 | 1 |
| 2018 Mayo | 2 | 0 | 2 |
| 2018 Abril | 2 | 0 | 2 |
| 2018 Marzo | 1 | 0 | 1 |
| 2018 Febrero | 12 | 2 | 14 |
| 2018 Enero | 5 | 4 | 9 |
| 2017 Diciembre | 11 | 6 | 17 |
| 2017 Noviembre | 12 | 9 | 21 |
| 2017 Octubre | 10 | 4 | 14 |
| 2017 Septiembre | 12 | 11 | 23 |
| 2017 Agosto | 16 | 14 | 30 |
| 2017 Julio | 16 | 5 | 21 |
| 2017 Junio | 21 | 19 | 40 |
| 2017 Mayo | 7 | 13 | 20 |
| 2017 Abril | 23 | 33 | 56 |
| 2017 Marzo | 13 | 30 | 43 |
| 2017 Febrero | 15 | 50 | 65 |
| 2017 Enero | 32 | 64 | 96 |
| 2016 Diciembre | 3 | 21 | 24 |
| 2016 Noviembre | 0 | 12 | 12 |
| 2016 Octubre | 0 | 10 | 10 |
| 2016 Agosto | 1 | 1 | 2 |
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