摘要
患者，女，47岁，住院号498534。因发热4天，面部、四肢散发疼痛性红色
斑块3天于2002年12月28日以Sweet综合征收入院。患者于2002年12月24
日无明显诱因，突然感畏寒，发热，当日体温未测，亦未治疗，次日面部和四肢
出现斑块伴疼痛，此后症状加重。12月27日来我院就诊，初诊为结节性红斑，给
予“川芎嗪片，穿王消炎片”等口服，未见好转，皮疹继续增多，12月28日再次
来我院复诊，考虑为Sweet综合征，收院治疗。该患者有高血压病史，甲状腺乳
头癌术后2年，既往无药物过敏史，无肝炎结核病史。
体检：体温37．6℃，脉搏98次／分，呼吸19次／分，血压130／70mmHg，神志
清楚，口腔无溃疡，心肺听诊未见异常，肝脾肋下未触及。皮肤科检查：双眼睑、
额部、双手背可见散在红色斑块，边缘隆起，部分呈假性水疱样损害，斑块小如
蚕豆大小，大至2cm~4cm，圆形或卵圆形，触之中等硬度，有触痛。右小腿可见
结节性损害，触痛(见图1)。
实验室检查：常规检查见附表1。尿粪常规正常。C反应蛋白为阳性。甲胎蛋
白，T3、T4、TSH正常，癌胚抗原，乳腺癌相关抗原，卵巢癌相关抗原，及胃肠
癌相关抗原等项检查均阴性。住院期间，两次胸部正位片正常，肝、胆、脾、肾、
输卵管、膀胱B超未见异常。骨髓细胞学检查属正常骨髓象，甲状腺B超无异常。
2002年12月31日左前臂皮损部位行活检，病理活检报告：表皮角化过度，角化
不全，真皮乳头高度水肿，真皮密集的成熟中性粒细胞浸润，有核尘，并可见毛
细血管扩张。诊断：Sweet综合征(见图2、图3、图4、图5)。
入院后给予抗感染治疗，克林霉素注射剂1．5g静脉滴注，每日一次。入院2
天体温波动在37．6．38．5℃，皮损无好转，而患者特征性皮疹及实验室检查基本符
合Sweet综合征的诊断，加用强的松30mg，每日一次，当日夜间体温正常，2天
后斑块颜色明显减退，触痛明显减轻，用药9天后，斑块变小变平，颜色基本消退，
无触痛。但患者于2003年元月8日诉咳嗽，2天后原部位皮疹复发，加用秋水仙
碱0．5mg，每日3次，用药一周后皮损改善，秋水仙碱减量为0．5mg，每日2次。
2周后无新发皮疹出现，患者于2003年2月1日出院。门诊定期随诊，秋水仙碱
逐渐减量，于2月10日停用，改用碘化钾10mL，每日3次，强的松逐渐减量，
于6月2日停用强的松及碘化钾，皮损无复发。
The patient, 47 years old, was a female. She was diagnosed as Sweet's syndrome and hospitalized on December 28, 2003, because of fever for 4 days and distributive painful red plaque on the face and extremities for 3 days. 4 days before hospitalization the patient without any cause suddenly began to feel chilly and have fever but have not measured her temperature. Without any treatment, painful skin eruption occurred on the face and limbs next day. After that the symptoms didn't get any remission. Then on December 27, she was diagnosed as erythema nodosum in our hospital and administrated orally with ligustrazine tablets and Chuanwang eliminate inflammation tablets. However, the next day skin eruption was gradually increased. So she was hospitalized into our hospital with Sweet's syndrome. The patient had no history of drug allergy. She had history of hypertension and had been operated 2 years ago due to papillary carcinoma of thyroid.
Physical examination T 37.6, P 98 /min, R 19 /min, BP 130/70mmHg. Her mind was clear .She had not oral aphthae. Ausculation of heart and lung wasn't found abnormality and liver and spleen were not touched under rib.
Dermatologic examination Scattered red plaques with margin border some of which had pseudovesicular lesions were found on the eyelids, frontal part and both bank of the hands. Some were as small as broad bean and some were as big as 2cmx4cm. These plaques were round or ellipse and had middle consistency and tenderness. Nodose lesions were observed on the right leg and had tenderness.
Laboratory findings On December 28, WBC 11.9xl09/L, N 81.7%, L 11.0%. On December 29, 2003, WBC 9.0x109/L, N 90.6%, L 7.4%. On January 7, 2003, WBC8.2x 109/L, N66.7%, L22.2%. On January 14, 2003, WBC 10.4xl09/L, N91.4%, L6.1%. On December 29, Urine and stool routines were normal and GPT and GOT in blood serum were 109U/L, 16 U/L, respectively. On January 7, 2003, GPT and GOT in blood serum were 55U/L, 16 U/L, respectively. On January 14, 2003, liver function was normal. On December 29, erythrocyte sedimentation rate was 78mm/h. On Jan 7, 2003, erymrocyte sedimentation rate became 29mm/h. On January 14, erythrocyte sedimentation rate was normal and C-response protein was positive, a -fetal protein, T3, T4, TSH, carcinoembryonic antigen, breast cancer-associated antigen, ovary-associated antigen and gastrointestinal cancer-associated antigen were normal. During hospitalization, upright chest x-ray was normal for two times and B ultrasound
showed no abnormality in liver, bile duct, spleen, kidney, uterine tube, bladder and thyroid. Cytology examination of bone marrow showed normal features. On Dec 31, 2002, biopsy of cutaneous lesions on left forearm showed hyperkeratosis of epidermis, parakeratosis, severe edema of dermal papillae, intensive infiltration of mature neutrophil in dermis, nuclear dust and capillary telangiectasia. The diagnosis of Sweet's syndrome was given.
Corticosteroids should be carefully used because the patient had hypertension and post-operation of papillary carcinoma of thyroid for 2 years. After hospitalization anti-infectious treatment was given and 1.5g clindamycin was intravenously administrated daily. In the first two days the temperature had fluctuated from 37.6 to 38.5 and cutaneous lesions had no improvement.The patient's characteristic skin lesions and laboratory examination were coincident with the diagnosis of Sweet's syndrom. After treatment with addional 30 mg prednisone daily, fever didn't occur in the same night and for 2 days the color of plaque markedly declined with relief of tenderness. After drug administration for 9 days, the plaques became small and flat without any tenderness and their color faded on the whole. However, the patient complained of cough on January 8, 2003 and cutaneous eruption relapsed on the original locus. Then 0.5 mg colchicine was given three times per day and cutaneous lesions began to relieve after one week's treatment. After that, colchicine was decreased to 0.5 mg two times each day. 2 weeks later, no new skin eruption oc
引文
1. Odom R B, James MD, Berger T G, et al. Anderws' Diseases of the skin; Clinical Dematology.W.B Saunders 2001,155-157.
2. Cohen PR, Kurzrock R. Sweet's syndrome: a aneutrophilic dermatosis classically associated with acute onset and fever. Clin Dermatol 2000; 18:265-282
3. Honigsmann H, Cohen PR, Wolff K. Acute febrile neutrophilic dermatosis (Sweet's syndrome). In: Freedberg IM, Eisen AZ, Wolff K, et al. editors. Fitzpatrick's dermatolgy in general medicine, 5th ed. New York: McGraw-Hill, 1999:1117-1123
4. Sweet RD. An acute febrile neutrophilic dermatosis [J]. Br J Dermatol, 1964,76: 349-356.
5. Takimoto CH, Warnock M, Golden JA. Sweet's syndrome with lung involvement [J]. Am Rev Respir Dis, 1991, 143:177-I79.
6. Cohen PR, Kurzrock R. Sweet's syndrome and malignancy [J]. Am J Med, 1987, 82:1220-1226.
7. Sitjas D, Cuatrecasas M, De Moragas JM. Acute febrile neutriphilic dermatosis (Sweet's Syndrome). Int J Dermatol 1993,32:261-268.
8. Schneider DT, Schuppe H-C, Schwambom D, et al. Acute febrile neutrophilic dermatosis (Sweet's syndrome) as initial presentation in a child with acute myelogenous leukemia. Med Pediatr Oncol 1998; 31:178-181.
9. Lipp KE, Shenefelt PD, Nelson RP Jr, et al. Persistent Sweet's syndrome occurring in a child with a primary immunodeficiency. J Am Acad Dermatol 1999; 40:838-841.
10. Tuerlinckx D, Bodart E, Despontin K, et al. Sweet's syndrome with arthtitis in an 8-month-old boy. J Rheumatol 1999; 26:440-442.
11. Prasad P, V. Sweet's syndrome in an infant - repot of a rae case. International Journal of Dematology 2002,41,928-930.
12. Durani B, K. Case Report Drug-induced Sweet's syndrome in acne caused by different tetracyclines: case report and review of the literature. British Journal of Dermatology 2002; 147:558-562.
13. Myatt A E, Baker D J, Byfield D M. Sweet's syndrome: a report on the use of potassium iodide. Cline and Exp Dermatol, 1987, 12:345.
14. Horio T, Imamura S, Danno K, et al. Treatment of acute febrile neutrophilic dermatosis (Sweet's syndrome) with potassium iodide. Dermatologica 1980;
160:341-347.
15. Cohen PR, Kurzrock R. Sweet's syndrome: a review of current treatment options. Am J Clin Dermatol 2002,3(2) 117-131.
16. Suehisa S, Tagami H.treament of acute februle neutrolhilic dermatosis (Sweet's syndrome) with colchicine [letter]. Br J Dermatol 1981,105:483.
17. Sanchez MR. Miscellaneous treatments: thalidomide, potassium iodide, levamisole, clofazimine, colchicines, ane D-penicillamine. Clin Dermatol 2000,18:131-145.
18. Saxe N, Gordon W. acute febrile neutrophilic dermatosis (sweet's syndrone): four case reports. S Afr Med J 1978,53:253-256.
19. Wilson DM, John GR, Callen JP. Peripheral ulcerative keratitis: an extracutaneous neutrophilic disorder: report of a patient with rheumatoid arthritis, pustular vasculitis, pyoderma gangrenosum, and Sweet's syndrome with an excellent response to cyclosporine therapy. J Am Acad Dermatol 1999, 40:331-334.
20. Nobeyama Y, Kamide R. Sweet's syndrome with neurologic manifestation: case report and literature review. Int J of Dermatology 2003, 42:438-443.
21. Giasuddin ASM, E1-Orfi AHAM, Ziu MM, et al. Sweet's syndrome: Is the pathogenesis mediated by helper T cell type 1 cytokines? J Am Acad Dematol 1998,39:940-943.
22. Bourke JF, Jones JL, Fletcher A, et al. An immunohistochemical study of the dermal in filtrate and epidermal staining for interl eukins-1 in 12 case of Sweets's syndrome. Br J Dermatol, 1996,134: 705-709.