Clinical features, treatment, and outcome of granulocyte colony stimulating factor-induced sweet syndrome

• Published in: Archives of dermatological research 2024-10, Vol.316 (10), p.685, Article 685
• Main Authors: Wu, Zhaoquan, Sun, Wei, He, Binsheng, Wang, Chunjiang
• Format: Article
• Language: English
• Subjects: Adolescent; Adrenal Cortex Hormones - therapeutic use; Adult; Aged; Biopsy; Case reports; Child; Child, Preschool; Colony-stimulating factor; Corticosteroids; Dermatology; Edema; Female; Granulocyte colony-stimulating factor; Granulocyte Colony-Stimulating Factor - administration & dosage; Granulocyte Colony-Stimulating Factor - therapeutic use; Granulocytes; Humans; Leukocytes (granulocytic); Leukocytes (neutrophilic); Male; Medicine; Medicine & Public Health; Middle Aged; Original Paper; Patients; Retrospective Studies; Skin - drug effects; Skin - pathology; Steroids; Sweet Syndrome - chemically induced; Sweet Syndrome - diagnosis; Sweet Syndrome - drug therapy; Sweet Syndrome - pathology; Sweet's syndrome; Treatment Outcome; Young Adult
• ISSN: 1432-069X; 0340-3696; 1432-069X
• DOI: 10.1007/s00403-024-03414-1

Background Sweet syndrome (SS) is a rare dermatological adverse reaction caused by granulocyte colony-stimulating factor (G-CSF), but the characteristics of G-CSF-induced SS are unclear. This study aims to elucidate the characteristics of G-CSF-induced SS and offer guidance for its prevention and management. Methods We collected relevant case reports of G-CSF-induced SS by searching pertinent databases until June 30, 2024, and synthesized the data for retrospective analysis. Results A total of fifty patients were analyzed, with a median age of 44 years (1.7–77). The onset of SS occurred between 2 and 90 days post-administration, with a median onset time of 7 days. The predominant cutaneous manifestations included papules/plaques (74.0%), nodules (32.0%), and vesicles/bullae (24.0%). Fever presented in 74.0% of cases, while extra-cutaneous symptoms appeared in 32% of patients. Skin biopsy revealed key findings such as dermal diffuse neutrophil infiltration (97.8%), leukocytoclasis (19.1%), and dermal papillary edema (27.7%). Following both the cessation of G-CSF and systemic corticosteroids treatment, patients showed symptomatic improvement at a median interval of 7 days (2–70). Conclusion Clinicians should remain vigilant for the risk of SS during G-CSF administration. Skin biopsy plays a crucial role in confirming SS diagnosis. G-CSF-induced SS exhibits a favorable response to corticosteroids, and re-administration of G-CSF should be avoided due to the risk of symptom recurrence.