Caso Clinico #1

CASO

Anamnesi | Paziente di 50 anni, maschio caucasico lamenta febbre da alcuni giorni, anemia, trombocitopenia, neutrofilia, dolenzia lesionale cutanea. Nessun farmaco assunto


SOLUZIONE

Diagnosi |  Sindrome di Sweet su quadro paraneoplastico da AML sottotipo FAB M3 (promielocitica acuta) confermata alla biopsia

Descrizione lesione: Placca anulare policiclica bilobata, ad andamento centrifugo, pseudovescicolare con margini netti e rilevati, eritematosa con desquamazione marfginale ad anello

La sindrome di Sweet è una sindrome variegata dal punto di vista sia della presentazione che dell’eziologia ma grosso modo dividibile in 3 tronconi: forma classica, forma paraneoplastica e forma drug-related. Il caso presentato riguarda la forma paraneoplastica. Generalmente le forme paraneoplastiche si associano a concomintanti linfomi di Hodgkin, NHL, Leucemie mieloidi acute, sindromi mielodisplastiche, neoplasie del tratto genitourinario e GI, mieloma multiplo, carcinoma della mammella, melanoma. La diagnosi spesso è concomitante lo spreading del tumore sottostante ma può precedere (raro) o seguire l’insorgenza della neoplasia. C’è da dire che le forme paraneoplastiche raramente sono ben trattabili come le forme non paraneoplastiche ed il trattamento della neoplasia sottostante raramente migliora i sintomi. Il trattamento elettivo è comunque quello steroideo

Piccola nota sulle sindromi paraneoplastiche:
Le sindromi paraneoplastiche sono un gruppo di patologie che seguono lo sviluppo di un tumore solido od ematico e ne sono direttamente causati per mezzo del rilascio da parte delle neoplasie di fattori di crescita o ormoni quali FGF, EFG, TGF-Alpha e così via. Le sindromi paraneoplastiche sono generalmente associate a cattiva prognosi e seguono l’andamento della malattia, possono essere una spia in casi non diagnosticati e in genere regrediscono al regredire della patologia tumorale che le alimenta. In generale possono esserci sindromi paraneoplastiche a componente endocrina, altre a componente dermatologica, altre a componente nervosa e così via. Tra quelle cutanee rammento la sindrome di Sweet, l’acrocheratosi paraneoplastica di Bazex, il pemfigo paraneoplastico, la dermatomiosite, l’achantosi nigrans, l’osteoartropatia ipertrofica, la vasculite leucocitoclastica, la papillomatosi cutanea florida, l’ipertricosi lanuginosa, il Paget extra mammario, il segno di Leser- Trelat (cheratosi seborroiche multiple sul dorso), il cheratoderma palmoplantare, l’ittiosi acquisita, la pitiriasi rutunda, il tripe palms, la reticoloistiocitosi multicentrica paraneoplastica, l’eritrodermia paraneoplastica

Redazione | Nato a Torre del greco il 27/03/1992 5°anno facoltà di medicina e chirurgia Federico II Napoli Appassionato di molte discipline diverse la medicina rappresenta sicuramente la più importante. Non disdegno alcun settore ma le branche che più mi interessano sono quelle della diagnostica clinica, della dermatologia, della ricerca oncologica, della farmacologia, della pediatria e della medicina interna. La mia idea di medico è quella di un lavoro di gruppo che possa essere parte di un team multidisciplinare ben strutturato che garantisca ai pazienti un iter di cura completo ed efficace. Spero un giorno di poter fare esperienze anche in zone di guerra specialmente in medio oriente magari con MSF o Emergency

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