Sweet syndrome in a child with aplastic anemia receiving recombinant granulocyte colony-stimulating factor.
OBJECTIVE
To elucidate the pathogenesis of Sweet syndrome, one patient with aplastic anemia was evaluated.


METHODS
A 15-year-old girl presented with intermittent fever and progressive pallor for 3 months after non-A, non-B, non-C hepatitis. Aplastic anemia was diagnosed and therapy was begun with recombinant granulocyte colony-stimulating factor (G-CSF), methylprednisolone pulse therapy, antilymphocyte globulin and cyclosporin A. There was only an increase in the neutrophil counts. We continued G-CSF therapy of 300 micrograms/m2 on alternate days for 7 months. At this time the white blood cell count was 10,000/microliters and the patient developed high-grade fever and a painful, erythematous, tender plaque (3 X 3 cm) on the left thigh. We diagnosed the lesion as a skin infection and stopped G-CSF therapy and started antibiotics. Cultures were negative. The lesion slowly resolved, G-CSF was restarted after 2 months, and 1 month later disseminated lesions occurred. Antibiotic therapy was not effective.


RESULTS
Biopsy of the lesion demonstrated infiltration of the dermis by sheets of neutrophils. We stopped G-CSF and began corticosteroid therapy. The skin lesions resolved rapidly.


CONCLUSIONS
We postulated that Sweet syndrome was induced by G-CSF treatment.
Shimizu
T
T
Department of Pediatrics and Child Health, Kurume University, School of Medicine, Kurume, Japan.
Yoshida
I
I
Eguchi
H
H
Takahashi
K
K
Inada
H
H
Kato
H
H
D000293:Adolescent; D000741:Anemia, Aplastic / Q000097:blood / Q000628:therapy*; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007958:Leukocyte Count; D008775:Methylprednisolone / Q000627:therapeutic use; D009504:Neutrophils / Q000473:pathology; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D012867:Skin / Q000473:pathology; D016463:Sweet Syndrome / Q000097:blood / Q000139:chemically induced* / Q000473:pathology
D000961:Antilymphocyte Serum; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D016572:Cyclosporine; D008775:Methylprednisolone