title: Neutrophilic dermatosis after azathioprine exposure.
abstract: OBJECTIVE
  Azathioprine hypersensitivity syndrome can present clinically and histopathologically like Sweet syndrome. Shared clinical features include fever, constitutional symptoms, prompt response to systemic corticosteroid therapy, neutrophilia, and abrupt onset of erythematous cutaneous lesions. Histologically, both azathioprine hypersensitivity syndrome and Sweet syndrome are rich in neutrophils.
  
  
  METHODS
  An 81-year-old woman with Crohn disease presented with fever and an acute eruption of plaques on her extremities within 2 weeks of starting treatment with azathioprine. Laboratory evaluation was notable for leukocytosis and neutrophilia. Skin biopsy of an erythematous plaque on the thigh demonstrated a suppurative folliculitis. Azathioprine treatment was discontinued resulting in resolution of the clinical lesions within 5 days. Our case was compared with 18 cases with similar clinical features.
  
  
  CONCLUSIONS
  We report a case of azathioprine hypersensitivity syndrome and review the literature on azathioprine-induced eruptions with features of Sweet syndrome. Our patient's distribution of lesions on the extremities and the finding of suppurative folliculitis on histopathology were not classical for Sweet syndrome. Azathioprine hypersensitivity syndrome seems to be a neutrophil-driven dermatosis; therefore, many overlapping features with Sweet syndrome are not surprising. Due to the potential for anaphylaxis with azathioprine rechallenge, a better term for a Sweetlike presentation in the setting of azathioprine administration is azathioprine hypersensitivity syndrome.
authors.affiliation: Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510, USA.
authors.forename: Nika
authors.initials: N
authors.lastname: Cyrus
authors.forename: Robert
authors.initials: R
authors.lastname: Stavert
authors.forename: Ashley R
authors.initials: AR
authors.lastname: Mason
authors.forename: Christine J
authors.initials: CJ
authors.lastname: Ko
authors.forename: Jennifer Nam
authors.initials: JN
authors.lastname: Choi
mesh_terms: D000369:Aged, 80 and over; D001379:Azathioprine / Q000009:adverse effects*; D003424:Crohn Disease / Q000188:drug therapy; D003937:Diagnosis, Differential; D003875:Drug Eruptions / Q000175:diagnosis* / Q000276:immunology* / Q000473:pathology; D005260:Female; D006801:Humans; D009504:Neutrophils; D016463:Sweet Syndrome / Q000175:diagnosis*
chemical_list: D001379:Azathioprine