Sweet… Or not so sweet?
Authors: Cristina Saldanha1; Eduardo
Rodrigues1; Hugo Leme1; Ana Cristina
Gouveia1
1 - Machico Health Center, SESARAM, Madeira Island, Portugal
Correspondence: Cristina Saldanha –
cristina-saldanha@hotmail.com
Key Clinical Message: Skin lesions compatible with Sweet
Syndrome lead to the suspicion of multiple etiologies. Despite being
uncommon, it is important to recognize it and know how to act, mainly
due to its association with tumors and drugs.
Abstract: Sweet Syndrome, or acute febrile neutrophilic
dermatosis, is characterized by tender erythematous skin lesions (Figure
1 and 2) frequently associated with fever and leukocytosis. Despite
being an uncommon inflammatory disease, it is triggered by infections,
pregnancy, drugs and malignancy. We report a case of a man diagnosed
with Sweet Syndrome.
This case was previously presented as a poster at Update em Medicina
2022, on May 2022.
Framework: Sweet Syndrome is an uncommon, febrile inflammatory
skin disease secondary to malignancy, infections and medications.
Case description: A 58-year-old male presented to a peripheral
urgency center with complaints of a sudden skin rash located on his
forehead, scalp, and neck (Figures 1 and 2) with three days of
evolution. He denied pain, itching, fever and headaches. On examination,
we found erythematous-based papules, nodules and pustules arranged in
well demarked plaques on his forehead, scalp and cervical region. The
patient denied chronic diseases, recent infections, heavy alcohol use
and drug abuse. Oral prednisolone treatment was initiated, and complete
blood count, biochemical, serological tests and chest x-ray only
revealed a slight leukocytosis. After five days since the onset of
prednisolone, the skin lesions had a marked regression (Figures 3 and
4). Complete resolution occurred after 35 days of the completion of
the corticosteroid cycle.
Discussion: When facing Sweet Syndrome, it is essential to
search for possible etiologies, since they have a high
burden1,2,3. A patient-centered approach, with the
investigation of potential causes and predisposing factors, combined
with a sharp physical examination, effectively managed the case.
Subsequent further studies and therapeutic with oral prednisolone
prevented exacerbation of the lesions, as well as allowed for a faster
etiological investigation2. Evaluation for
malignancy should be considered when no other cause was established and
there is reasonable suspicion. However, if no malignancy is identified
we must be alert as it may appear in the following
years2,3.
Briefly, carrying out a complete clinical history, physical examination
and a close follow-up of the patient is the key on the management of
suspicions of this syndrome.
Conclusion: Despite being uncommon, Sweet Syndrome is a
diagnosis to consider when facing sudden skin lesions on an adult. After
conclusion of idiopathic etiology, patient follow-up is recommended.
Keywords: Sweet Syndrome; malignancy; management; follow-up
Funding information: none.
Acknowledgments: none.
Conflict of interest: none.
Consent statement: Written informed consent was obtained from the
patient to publish this report in accordance with the journal’s patient
consent policy.
Author Contributions:
Cristina Saldanha: Responsible for acquisition of data, patient consent
statement, library research and writing the manuscript.
Eduardo Rodrigues: Responsible for revising the manuscript and providing
clinical judgement.
Hugo Leme: Responsible for acquisition of data and patient consent
statement.
Ana Cristina Gouveia: Responsible for critical revision of the
manuscript.