Bullous Sweet’s Syndrome: Report of an Atypical Case Presenting with Ring-Like, Figurate Lesions

©Copyright 2017 by Turkish Society of Hematology Turkish Journal of Hematology, Published by Galenos Publishing House Received/Geliş tarihi: May 16, 2015 Accepted/Kabul tarihi: June 15, 2015 Address for Correspondence/Yazışma Adresi: Andaç SALMAN M.D., Marmara University Faculty of Medicine, Department of Dermatology, İstanbul, Turkey Phone : +90 216 657 06 06-3533 E-mail : [email protected], [email protected] A 68-year-old woman presented with a 2-month history of erythematous, blistering lesions refractory to systemic antibiotic treatment. Her medical history was insignificant except for longstanding diabetes mellitus, hepatitis C infection, and recently diagnosed myelodysplastic syndrome, refractory anemia with excess blasts-1 (MDS-RAEB-1). She denied any recent intake of drugs prior to the onset of skin lesions. Dermatological examination revealed widespread, erythematous, concentric, circinate large plaques with peripheral bullae formation over the trunk and extremities (Figures 1A and 1B). Laboratory tests disclosed leukocytosis (32x109/L) with neutrophilia (7.2x109/L), anemia (hemoglobin: 76 g/L), thrombocytopenia (16x109/L), elevated levels of C-reactive protein (1133.36 nmol/L) and erythrocyte sedimentation rate (111 mm/h), normal levels of aspartate aminotransferase (0.17 μkat/L) and alanine aminotransferase (0.22 μkat/L), and hepatitis C virus-ribonucleic acid (HCV-RNA) negativity. A punch biopsy was obtained with a differential diagnosis of bullous Sweet’s syndrome (SS) and erythema gyratum repens. Histopathology showed diffuse, dermal inflammatory infiltrate rich in neutrophils with subepidermal blister formation (Figure 2). Clinical and laboratory findings confirmed the diagnosis of bullous SS associated with MDS-RAEB-1. In addition to topical corticosteroids and oral colchicine, treatment with azacitidine led to rapid resolution of 1Marmara University Faculty of Medicine, Department of Dermatology, İstanbul, Turkey 2Marmara University Faculty of Medicine, Department of Hematology, İstanbul, Turkey 3Marmara University Faculty of Medicine, Department of Pathology, İstanbul, Turkey Andaç Salman1, Aida Berenjian1, Ali Eser2, Fatma Dilek Kaymakçı3, Leyla Cinel3, Işık Kaygusuz Atagündüz2, Deniz Yücelten1, Tülin Ergun1 Büllöz Sweet Sendromu: Halka Benzeri, Figüre Lezyonlarla Ortaya Çıkan Atipik Bir Olgu Sunumu Bullous Sweet’s Syndrome: Report of an Atypical Case Presenting with Ring-Like, Figurate Lesions DOI: 10.4274/tjh.2015.0202 Turk J Hematol 2017;34:118-119