We report a rare case of sterile neutrophilic dermatosis (Sweet\'s syndrome) accompanied by systemic inflammatory response syndrome. A 5-year-old, neutered male Maltese dog presented with extensive crusts on the whole-body surface and multifocal erosions and plaques on the four limbs. The lesions had been present for two months and did not respond to antibiotics before the presentation. In addition, the dog was lethargic, anorexic, and febrile, with joint swelling. A clinicopathologic analysis revealed neutrophilic leukocytosis with left shift and increased C-reactive protein level. Furthermore, a histopathological examination showed moderate to severe inflammatory infiltrates consisting predominantly of neutrophils from the superficial to the deep dermis. There was no evidence of bacterial or fungal infections, and autoimmune diseases, such as pemphigus, systemic lupus erythematosus, and erythema multiforme, were excluded. Sweet\'s syndrome, a rare skin disorder, associated with systemic inflammation was diagnosed, and the cutaneous lesions and systemic inflammation disappeared after prolonged steroid administration.

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BACKGROUND: Sterile neutrophilic dermatosis is a rare disease in dogs, similar to Sweet\'s syndrome in humans. This case report describes the treatment of a 2-year old Bearded Collie that was presented with a 3-week history of fever, hind-limb weakness, peripheral lymphadenomegaly and leucocytosis. Blood tests revealed severe leukocytosis, renal azotaemia, elevated liver enzymes and bilirubinaemia. Skin lesions started to appear in week four. Histology revealed a sterile neutrophilic dermatitis resembling Sweet\'s syndrome. The dog displayed extracutaneous manifestations, including fever, polyarthritis, a severe leukemoid reaction, anaemia, hepatopathy and nephropathy. Issues regarding the use of criteria for the diagnosis of Sweet\'s syndrome in humans that are used for dogs with sterile neutrophilic dermatosis, are discussed in this case report. The condition resolved with dexamethasone and mycophenolate mofetil as a novel steroid-sparing therapy. Three months later the dog relapsed, which rapidly responded to short-term dexamethasone treatment and temporarily increased mycophenolate mofetil dosage.
BACKGROUND: Sterile neutrophile Dermatose ist eine seltene Erkrankung bei Hunden, vergleichbar dem Sweet\'schen Syndrom beim Mensch. Dieser Fallbericht beschreibt die Behandlung eines zweijährigen Bearded Collie mit einer 3-wöchigen Vorgeschichte von Fieber, Schwäche der hinteren Gliedmaßen und peripherer Lymphadenomegalie und Leukozytose. Die Laborwerte wiesen eine schwere Leukozytose, renale Azotaämie, erhöhte Leberenzyme und Bilirubinämie auf. Hautveränderungen zeigten sich ab der vierten Woche. Die Histologie ergab eine sterile neutrophile Dermatitis, die dem Sweet’schen Syndrom ähnelt. Zusätzlich wurden extrakutane Manifestationen festgestellt, einschließlich Fieber, Poly­arthritis, eine schwere Leukozytose, Anämie, Hepatopathie und Nephropathie. Der vorliegende Fallbericht diskutiert Fragen inwieweit Kriterien für die Diagnose des Sweet-Syndroms beim Menschen bei Hunden mit steriler neutrophiler Derma­tose verwendet werden können. Eine steroidschonende Therapie mittels Dexamethason und Mycophenolat-Mofetil führte zu einer Abheilung. Drei Monate später erlitt der Hund einen Rückfall, der rasch und kurzfristig auf die Behandlung mit Dexamethason und einer erhöhten Mycophenolat-Mofetil-Dosierung reagierte.
BACKGROUND: La dermatose neutrophilique stérile est une maladie rare chez le chien, semblable au syndrome de Sweet chez l’homme. Ce rapport de cas décrit le traitement d’un Bearded Collie de 2 ans présentant des antécédents de fièvre pendant 3 semaines, une faiblesse des membres postérieurs, une lymphadénomégalie périphérique et une leucocytose. Les analyses de sang ont révélé une leucocytose grave, une azotémie rénale, une élévation des enzymes hépatiques et une bilirubinémie. Des lésions cutanées ont commencé à apparaître à la quatrième semaine. L’histologie a révélé une dermatite neutrophilique stérile ressemblant au syndrome de Sweet. Le chien présentait des manifestations extracutanées telles que fièvre, polyarthrite, réaction leucémoïde sévère, anémie, hépatopathie et néphropathie. Les questions relatives à l’utilisation des critères de diagnostic du syndrome de Sweet chez l’homme chez les chiens atteints de dermatose neutrophilique stérile sont abordées dans le présent rapport de cas. La maladie a été traitée avec la dexaméthasone et le mycophénolate mofétil en tant que thérapie innovante permettant d’économiser des stéroïdes. Trois mois plus tard, le chien a rechuté mais a rapidement répondu à un traitement de courte durée à la dexaméthasone et à une augmentation temporairement la dose de mycophénolate mofétil.
BACKGROUND: La dermatosi neutrofila sterile è una malattia rara nei cani ed è simile alla sindrome di Sweet negli esseri umani. Questo studio descrive il trattamento di un bearded collie di 2 anni che è stato presentato con una storia di febbre di 3 settimane, debolezza degli arti posteriori, linfoadenomegalia periferica e leucocitosi. Gli esami del sangue hanno rivelato grave leucocitosi, azotemia renale, enzimi epatici elevati e bilirubinemia. Le lesioni cutanee sono apparse alla quarta settimana. L’istologia ha rivelato una dermatosi neutrofila sterile simile alla sindrome di Sweet. Il cane mostrava delle manifestazioni extracutanee, compresa febbre, poliartrite, una reazione leucemoide severa, anemia, epatopatia e nefropatia. In questo studio viene discussa la questione dell’uso dei criteri per la diagnosi della sindrome di Sweet negli esseri umani che vengono utilizzati per i cani affetti da dermatosi neutrofila sterile. La patologia si è risolta con l’assunzione di desametasone e micofenolato mofetile come nuova terapia a effetto di risparmio di steroidi. Tre mesi dopo il cane ha avuto una ricaduta. Il cane ha reagito rapidamente al trattamento a breve termine con desametasone e un dosaggio aumentato temporaneamente di micofenolato mofetile.

An 8-year-old castrated male Bichon Frise was presented to the Kansas State University Veterinary Health Center for evaluation of unilateral right-sided exophthalmos, suspected secondary to a retrobulbar abscess. The dog had acutely developed right-sided periorbital swelling, exophthalmos with pain on retropulsion, as well as multiple cutaneous exudative plaques on the feet and tail base. On ophthalmic examination, the dog also exhibited mild left-sided exophthalmos with decreased, nonpainful retropulsion. Orbital ultrasound and CT were performed to evaluate the extent of bilateral orbital disease. Incisional biopsies were obtained from the affected right periorbital tissues and skin of the feet, and histopathology revealed severe neutrophilic inflammation of the dermis with no organisms detected. Histologic changes were consistent with sterile neutrophilic dermatosis. The dog achieved clinical remission following treatment with initial immunosuppressive doses of corticosteroids and subsequent long-term maintenance therapy using oral cyclosporine.