Case Report

Myocarditis Concurrent with Sweet Syndrome: A Presentation of Acute Myeloid Leukemia

Table 2

Cases of sweet syndrome with concurrent myocarditis.

Age/sexSuspected etiologyFactors supporting diagnosis of sweet syndromeFactors supporting diagnosis of myocarditisTherapy administeredOutcomeAuthor

40/FMesalamine (drug induced)Edematous and erythematous plaques with some central blistering and erosions, located on the arm, neck, and palate.Fever, acute shortness of breath, and chest pain.Topical clobetasol cream, 6 weeks of indomethacin + colchicine, and mesalamine discontinuedResolution of myopericarditis within 20 days; no skin lesions at 6 weeks of follow-upShabtaie et al. [14]
Biopsy: inflammatory infiltrate of the dermis, consisting of neutrophils and leukocytoclasis.Troponin T 0.12 ng/mL (elevated) and CRP 184 mg/L (elevated).
ECG: diffuse ST elevations.
Cardiac MRI: diffuse pericardial enhancement and edema.

64/FMyelodysplastic syndromeMovable, tender, erythematous, cutaneous nodule of 1.5 cm × 1.5 cm at the inner aspect of the right lower leg. Skin biopsy demonstrated acute febrile neutrophilic dermatosis.Clinically, the patient had symptoms consistent with myocarditis.Prednisolone 30 mg/dayDeath secondary to sudden cardiac arrest 3 days after presentationShimizu [15]
Cardiac MRI: a small amount of pericardial effusion and slightly dilated LA. Postmortem heart biopsy: perivascular and myocardial neutrophil infiltration.

41/MIdiopathicPainful erythematous papules and plaques on the nape, neck, shoulders, and arms, as well as painful hyperpigmented subcutaneous nodules. Skin biopsy: subepithelial edema, dermal inflammatory infiltrate with polymorphonuclear predominance and absence of vasculitis.EKG changes and elevated cardiac biomarkers.Oral prednisolone 1 mg/kg/dayComplete resolution of symptoms within 4 days of presentationGraça-Santos et al. [16]
Cardiac MRI: patchy subepicardial enhancement and slight edema in the inferolateral wall.

42/MG-CSF administration“New skin lesions compatible with sweet syndrome reactivation.” Sweet syndrome had previously been confirmed on biopsy in an episode 1 year prior.Myocardial biopsy revealed interstitial edema and perivascular neutrophil infiltrate. Additionally, an echocardiogram with new LV systolic dysfunction and CXR with enlarged cardiac silhouette.Hydrocortisone 1 mg/kg/day, with noninvasive ventilation and IV diureticsClinical parameters, invasive monitoring values, and ventricular function normalized at 48 hoursDíaz et al. [17]

CXR: chest X-ray; CRP: C-reactive protein; ECG: electrocardiogram; LA: left atrium; LV: left ventricle.