Acta Dermato-Venereologica 99-2CompleteContent | Page 25
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SHORT COMMUNICATION
Two Cases of Acute Febrile Neutrophilic Dermatosis Thought to be Caused by Topical Clindamycin
Kiriko NITTA, Yoko KANO, Yukiko USHIGOME, Jun HAYAKAWA and Tetsuo SHIOHARA
Department of Dermatology, Kyorin University School of Medicine, 6-20-2 Shinkawa Mitaka, Tokyo 181-8611, Japan. E-mail: yukta@
ks.kyorin-u.ac.jp
Accepted Aug 29, 2018; E-published Sep 3, 2018
Acute febrile neutrophilic dermatosis (AFND), or
Sweet’s syndrome, is characterized by the sudden onset
of pyrexia, peripheral neutrophilia, and erythematous
skin lesions, comprising massive neutrophilic infiltration
in the dermis. Onset can be linked to various factors,
including infection, inflammatory bowel disease (IBD),
malignancy and medication. Drug-induced AFND (Di-
AFND) is commonly associated with systemic admi-
nistration of drugs. Clindamycin (CLD)-induced AFND
has been documented in only a small number of cases
(1, 2). Although topical CLD for acne has been used for
many years, the frequencies of contact dermatitis and
phototoxic reactions are low (3–7).
We report here 2 cases with unusual AFND, thought
to be induced by CLD, with positive lymphocyte trans-
formation test (LTT) or patch testing. Chemical peeling
and light exposure might have led to the development
of AFND in these patients.
CASE REPORTS
Case 1. A 23-year-old woman presented to our clinic with ery
thema, pustules and abscesses on the face and legs, together with
high fever. Thirty-eight days prior to this first visit, she had started
Clindamycin ® Gel 1% (Kracie Pharmaceutical Ltd., Tokyo, Japan)
just after a first chemical peeling procedure with 30% salicylic acid
dissolved in macrogol for acne in an aesthetic dermatology clinic.
Thirty-three days prior to her visit, chemical peeling was repeated.
After the first treatment, intense pulsed light (IPL) (wavelengths
560–1,200 nm) was attempted instead of chemical peeling. She
had been applying CLD until the day before her first visit despite
the exacerbation. On examination, numerous pustules and absces-
ses with painful erythematous lesions were identified on her face
(Fig. 1A), trunk and limbs where CLD had never been applied.
No arthralgia or muscle pain was detected. Laboratory testing
revealed elevations of both the white blood cell (WBC) count
(15.2×10 3 /mm 3 ; 80.5% neutrophils) and the concentration of C-
reactive protein (CRP) (7.3 mg/dl; normal, < 0.03 mg/dl). Results
of bacteriological cultures from an abscess on the neck and blood
yielded negative results. Computed tomography showed no solid
tumour or lymphoproliferative disorder. Skin biopsies from the
neck and leg revealed neutrophilic pustules in the epidermis and
a dense inflammatory infiltrate, mainly comprising neutrophils,
throughout the entire dermis (Fig. 1B and Fig. S1 1 ). Leukocyto-
clastic vasculitis was absent. Based on these findings, a diagnosis
of AFND or acne fulminans (AF) was suspected. Positive results
were obtained from the LTT for CLD (stimulation index (SI)
10.28; positive ≥ 1.81) on her first visit, although patch testing
for 10% petrolatum-based CLD had shown negative results. A
diagnosis of CLD-induced AFND or AF was made. Oral predni-
https://www.medicaljournals.se/acta/content/abstract/10.2340/00015555-3019
1
doi: 10.2340/00015555-3019
Acta Derm Venereol 2019; 99: 228–229
Fig. 1. Case 1. (A) Subcutaneous abscesses and pustules on the face
with peri-orbital and nasal sparing. (B) Epidermal and dermal infiltration of
inflammatory cells (haematoxylin-eosin (HE) stain; original magnification
×40).
solone (PSL) was then started at 30 mg/day, and her symptoms
promptly resolved.
Case 2. A 42-year-old woman presented with severe pustular
eruptions and high fever. Four weeks prior to presentation, she
had started oral PSL, 30 mg/day, for exacerbation of alopecia and
facial erythema due to pre-existing systemic lupus erythematosus
(SLE). Because she developed steroid-induced acne on the face,
she had resumed using Dalacin ® T Gel 1% (Sato Pharmaceutical
Ltd, Tokyo, Japan). She had experienced no adverse effects with
Fig. 2. Case 2. Erythema has coalesced into plaques studded with
monomorphic pustules.
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Journal Compilation © 2019 Acta Dermato-Venereologica.