Po \u00favodn\u00edm klinick\u00e9m vy\u0161et\u0159en\u00ed byl pacient s n\u00e1hl\u00fdmi, bolestiv\u00fdmi erytemat\u00f3zn\u00edmi l\u00e9zemi na obli\u010deji a krku urgentn\u011b odesl\u00e1n na dermatologick\u00e9 odd\u011blen\u00ed. Po konzultaci se l\u00e9ka\u0159sk\u00fd t\u00fdm rozhodl vysadit pacientovi ned\u00e1vno p\u0159edepsanou medikaci. Bylo zah\u00e1jeno komplexn\u00ed diagnostick\u00e9 vy\u0161et\u0159en\u00ed, v\u010detn\u011b biopsie k\u016f\u017ee, kompletn\u00edho krevn\u00edho obrazu a laboratorn\u00edch test\u016f na protil\u00e1tky, lupus antikoagulant a r\u016fzn\u00e9 s\u00e9rologick\u00e9 markery. Pro zvl\u00e1dnut\u00ed symptom\u016f pacient zah\u00e1jil re\u017eim peror\u00e1ln\u00edch kortikosteroid\u016f.<\/p>\n\n\n\n
B\u011bhem 48 hodin od l\u00e9\u010dby se intenzita ko\u017en\u00edch l\u00e9z\u00ed znateln\u011b zm\u00edrnila a souvisej\u00edc\u00ed bolest ustoupila. Laboratorn\u00ed v\u00fdsledky potvrdily p\u0159\u00edtomnost leukocyt\u00f3zy doprov\u00e1zen\u00e9 neutrofili\u00ed, stejn\u011b jako p\u0159\u00edtomnost protil\u00e1tek a lupusov\u00e9ho antikoagulancia, zat\u00edmco rutinn\u00ed s\u00e9rologick\u00e9 testy p\u0159inesly negativn\u00ed v\u00fdsledky. O dvacet dn\u00ed pozd\u011bji patologick\u00e1 zpr\u00e1va z ko\u017en\u00ed biopsie potvrdila diagn\u00f3zu Sweetova syndromu.<\/p>\n\n\n\n
Sweetov syndrom, l\u00e9ka\u0159sky zn\u00e1m\u00fd jako akutn\u00ed febriln\u00ed neutrofiln\u00ed dermat\u00f3za, je vz\u00e1cn\u00fd dermatologick\u00fd stav za\u0159azen\u00fd mezi neutrofiln\u00ed dermat\u00f3zy. Histopatologicky je definov\u00e1n p\u0159\u00edtomnost\u00ed hust\u00fdch neutrofiln\u00edch infiltr\u00e1t\u016f v tk\u00e1ni. Klinicky se syndrom projevuje n\u00e1hl\u00fdm v\u00fdskytem bolestiv\u00fdch, erytemat\u00f3zn\u00edch papul\u00ed nebo plak\u016f. Tyto l\u00e9ze se obvykle objevuj\u00ed asymetricky na obli\u010deji, krku, horn\u00ed \u010d\u00e1sti trupu a rukou. Tento stav je \u010dasto doprov\u00e1zen syst\u00e9mov\u00fdmi p\u0159\u00edznaky, v\u010detn\u011b hore\u010dky a v\u00fdznamn\u00e9 leukocyt\u00f3zy s neutrofili\u00ed.<\/p>\n\n\n\n
P\u0159esn\u00e1 etiologie Sweetova syndromu z\u016fst\u00e1v\u00e1 nejist\u00e1, a\u010dkoli sou\u010dasn\u00fd v\u00fdzkum nazna\u010duje, \u017ee patogenezi \u0159\u00edd\u00ed cytokiny, kter\u00e9 usnad\u0148uj\u00ed chemotaxi a aktivaci neutrofil\u016f a histiocyt\u016f. V\u0161eobecn\u011b se p\u0159edpokl\u00e1d\u00e1, \u017ee se jedn\u00e1 o imunitn\u011b zprost\u0159edkovanou hypersenzitivn\u00ed reakci vyvolanou p\u0159edchoz\u00edmi faktory, jako jsou infekce horn\u00edch cest d\u00fdchac\u00edch, paraneoplastick\u00e9 procesy nebo pod\u00e1n\u00ed ur\u010dit\u00fdch farmaceutick\u00fdch l\u00e1tek. P\u0159esn\u00e1 diagn\u00f3za je nezbytn\u00e1, proto\u017ee stav vy\u017eaduje vylou\u010den\u00ed z\u00e1kladn\u00edch syst\u00e9mov\u00fdch onemocn\u011bn\u00ed, jako jsou skryt\u00e9 malignity, kter\u00e9 se mohou projevit jako atypick\u00e9 ko\u017en\u00ed l\u00e9ze na h\u0159betu rukou.<\/p>\n\n\n\n
I kdy\u017e syndrom m\u016f\u017ee b\u00fdt idiopatick\u00fd, p\u0159\u00edpady vyvolan\u00e9 l\u00e9ky jsou \u010dast\u011bj\u0161\u00ed u \u017een. Mezi l\u00e9ky \u010dasto spojovan\u00e9 s rozvojem Sweetova syndromu pat\u0159\u00ed antikoncepce, antiepileptika, antibiotika, antihypertenziva, vakc\u00edny a faktory stimuluj\u00edc\u00ed kolonie. Jak v\u0161ak tento p\u0159\u00edpad ukazuje, i jin\u00e9 l\u00e9ky mohou potenci\u00e1ln\u011b p\u016fsobit jako spou\u0161t\u011b\u010de.<\/p>\n\n\n\n
Zlat\u00fdm standardem pro po\u010d\u00e1te\u010dn\u00ed l\u00e9\u010dbu je pod\u00e1v\u00e1n\u00ed peror\u00e1ln\u00edch kortikosteroid\u016f. Pacienti obvykle vykazuj\u00ed rychlou odpov\u011b\u010f, p\u0159i\u010dem\u017e syst\u00e9mov\u00e9 diskomfort a bolest ustupuj\u00ed b\u011bhem prvn\u00edch n\u011bkolika hodin l\u00e9\u010dby a ko\u017en\u00ed l\u00e9ze vymiz\u00ed za m\u00e9n\u011b ne\u017e t\u00fdden. V tomto p\u0159\u00edpad\u011b vy\u017eadoval n\u00e1hl\u00fd v\u00fdskyt l\u00e9z\u00ed d\u016fkladnou diferenci\u00e1ln\u00ed diagnostiku k vylou\u010den\u00ed onemocn\u011bn\u00ed, jako je kop\u0159ivka, kontaktn\u00ed dermatitida, toxikodermie a ko\u017en\u00ed lupus. Integrace klinick\u00e9 anamn\u00e9zy, laboratorn\u00edch n\u00e1lez\u016f a p\u0159esv\u011bd\u010div\u00fdch histopatologick\u00fdch v\u00fdsledk\u016f biopsie umo\u017enila l\u00e9ka\u0159sk\u00e9mu t\u00fdmu dosp\u011bt k definitivn\u00ed diagn\u00f3ze Sweetova syndromu a zajistit, aby pacient dostal spr\u00e1vnou c\u00edlenou l\u00e9\u010dbu.<\/p>\n","protected":false},"excerpt":{"rendered":"Po \u00favodn\u00edm klinick\u00e9m vy\u0161et\u0159en\u00ed byl pacient s n\u00e1hl\u00fdmi, bolestiv\u00fdmi erytemat\u00f3zn\u00edmi l\u00e9zemi na obli\u010deji a krku urgentn\u011b odesl\u00e1n na dermatologick\u00e9 odd\u011blen\u00ed. Po konzultaci se \n [...]<\/a>","protected":false},"author":1,"featured_media":7952,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-7951","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blog"],"_links":{"self":[{"href":"https:\/\/fakt24.biz.ua\/index.php?rest_route=\/wp\/v2\/posts\/7951","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/fakt24.biz.ua\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/fakt24.biz.ua\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/fakt24.biz.ua\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/fakt24.biz.ua\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=7951"}],"version-history":[{"count":1,"href":"https:\/\/fakt24.biz.ua\/index.php?rest_route=\/wp\/v2\/posts\/7951\/revisions"}],"predecessor-version":[{"id":7953,"href":"https:\/\/fakt24.biz.ua\/index.php?rest_route=\/wp\/v2\/posts\/7951\/revisions\/7953"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/fakt24.biz.ua\/index.php?rest_route=\/wp\/v2\/media\/7952"}],"wp:attachment":[{"href":"https:\/\/fakt24.biz.ua\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=7951"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/fakt24.biz.ua\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=7951"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/fakt24.biz.ua\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=7951"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}