Microsoft Word - DRM154BF

Sweet’s syndrome, oral Malignancy Squamous-cell carcinoma A. Giménez-Arnau, MD, PhD, Department of Dermatology, Hospital del Mar, Passeig Maritim 25-29, E-08003 Barcelona (Spain) Sweet’s syndrome (SS) or acute febrile neutrophilic dermatosis [1] as marker of malignancy was suggested by Clemmensen et al. [2] in 1989. These patients show some of the severer cutaneous features of the disorder. The most relevant findings in this group of patients are: male predominance; vesicular, bullous and even ulcerative skin lesions; lower extremity, trunk and back location; oral mucous membrane involvement; anemia (83%); abnormal platelet counts (68%); absence of neutrophilia (53%); absence of pyrexia (12%); extracuta-neous involvement, particularly of the musculoskeletal and renal systems, and frequent recurrence of skin symptoms. SS usually precedes the diagnosis of the tumor or its recurrence [3]. Corticosteroid therapy is normally very effective regardless of the presence of malignancy. 10-20% of patients with SS have an associated neoplasm [4]. More than 85% of individuals with malignancy-associated SS had a hematologic disorder, particularly acute myelogenous leukemia, which occurs in 42% of patients. Solid tumors were observed in 15% of malignancy-associated SS. Hematologic malignancy together with a solid tumor has been described in few patients with malignancy-associated SS. The clinical update of SS requires the description of new peculiar cases. We report the first case of severe SS with multiple oral squamous-cell carcinoma and its clinical aspects, course and treatment. On August 9, 1993, a 48-year-old white man with a history of alcohol abuse and tobacco habit suffered the sudden development of multiple, erythematous and tender plaques and nodules that appeared ede-matous and somewhat vesicular. Some had a circinate pattern with central clearing and a peripheral vesicular ring (fig. 1). Some lesions formed ulcers and crusts. There were no mucosal abnormalities. Within a short time, the lesions spread from the upper extremities to the trunk, neck and face. The patient had malaise and fever. No weight loss was noted. Laboratory