Acute Febrile Neutrophilic Dermatosis (Sweet Syndrome)

Abstract

Background: Sweet syndrome (acute febrile neutrophilic dermatosis) is an inflammatory, neutrophil-predominant dermatosis that presents with abrupt onset of painful erythematous papules/plaques, fever and systemic symptoms. It may be idiopathic, drug-induced, or associated with systemic disease (including hematologic malignancy). Early recognition avoids unnecessary antibiotic exposure and enables targeted therapy.

Case Summary: Mr. X, a 35-year-old man, presented with 14 days of fever, chills, cough and painful erythematous papular rash of the upper limbs and face. Skin biopsy from an erythematous plaque on the left palm showed a dense neutrophilic dermal infiltrate with papillary dermal edema and leukocytoclasis without vasculitis. Lab tests revealed leukocytosis (WBC 14,760/mm³) with neutrophilia. Infectious and serologic screens (dengue, leptospira, hepatitis B/C, HIV, VDRL, Salmonella) were negative. He received IV fluids, empiric antibiotics, symptomatic/supportive therapy and topical agents with gradual clinical improvement. Histopathology plus clinical picture established the diagnosis.

Conclusion: This case illustrates a classical sweet syndrome presentation and highlights the importance of histopathology, consideration of underlying triggers (infectious, drug, or paraneoplastic) and that systemic corticosteroids remain first-line treatment when infection has been excluded. Multidisciplinary follow-up (dermatology, hematology) and targeted screening for malignancy are recommended.