A 39-year-old man sought evaluation of The multiple discrete, small, red, The patient was in no acute distress. The chest film was unremarkable. A tapering course of an oral corticosteroid
newly erupted skin lesions on his arms.
Ten days earlier he had fallen on his
forearms, but no bruises appeared at
painful marks on the forearms were
gradually enlarging. The patient denied
fever, chills, nausea, vomiting,
cough, or sore throat. He took no medications.
During the previous month,
he had lost 10 lb and become increasingly
No lymphadenopathy was detected.
The head, ear, eyes, nose, and
throat; neck; oropharynx; cardiovascular;
lung; abdominal; and rectal examinations
were unremarkable. Multiple
raised erythematous plaques on
the extensor and flexor surfaces of the
forearms bilaterally (Figure) were
noted; some of the lesions were tender
A complete blood cell count, electrolyte
levels, and liver function test results
were within normal limits. The erythrocyte
sedimentation rate (ESR) was
103 mm/h. A biopsy of one of the lesions
revealed a dense, dermal, perivascular
which confirmed the suspected diagnosis
of Sweet syndrome.
was prescribed; the disease
resolved in 6 weeks.
A 39-year-old man sought evaluation of
The multiple discrete, small, red,
The patient was in no acute distress.
The chest film was unremarkable.
A tapering course of an oral corticosteroid
In 1964, Robert Douglas Sweet described
an acute febrile neutrophilic
dermatosis in 8 women who
were between the ages of 32 and
55 years.1 Four cardinal features
were noted in these patients:
- Peripheral neutrophilia.
- Raised, painful plaques on the
limbs, face, and neck.
- Histologically dense dermal infiltration
with mature polymorphonuclear
In recent years, the eponym
"Sweet syndrome" has largely replaced
"acute febrile neutrophilic dermatosis"
because it is now recognized
that fever and neutrophilia are variable
features of the disease, extracutaneous
manifestations are common,
and chronic recurrent forms of
the disorder exist.2
1. Sweet RD. An acute febrile neutrophilic dermatosis.
Br J Dermatol. 1964;76:349-356.
2. Gunawardena DA, Gunawardena KA, Ratnayaka
RM, Vasanthanathan NS. The clinical spectrum of
Sweet's syndrome (acute febrile neutrophilic dermatosis):
a report of eighteen cases. Br J Dermatol.
3. von den Driesch P. Sweet's syndrome (acute
febrile neutrophilic dermatosis). J Am Acad Dermatol.
4. Fitzgerald RL, McBurney EI, Nesbitt LT Jr.
Sweet's syndrome. Int J Dermatol. 1996;35:9-15.
5. Cohen PR, Kurzrock R. Sweet's syndrome and
malignacy. Am J Med. 1987;82:1220-1226.
6. Jordaan HF. Acute febrile neutrophilic dermatosis:
a histopathological study of 37 patients and a review
of the literature. Am J Dermatopathol. 1989;
7. Cohen PR, Talpaz M, Kurzrock R. Malignancyassociated
Sweet's syndrome: review of the world
literature. J Clin Oncol. 1988;6:1887-1897.
8. Deguchi M, Tsunoda T, Yuda F, Tagami H.
Sweet's syndrome in acute myelogenous leukemia
showing dermal infiltration of leukemic cells.
9. Zillikens D, Goldstein RK, Elsner P, et al. Sweet's
syndrome associated with Salmonella typhimurium
infection. Acta Derm Venereol. 1991;71:77-79.
10. Elsner P, Hartmann AA, Lechner W. Sweet's
syndrome associated with Yersinia enterocolitica infection.
11. Gilmour E, Chalmers RJ, Rowlands DJ. Druginduced
Sweet's syndrome (acute febrile neutrophilic
dermatosis) associated with hydralazine.
Br J Dermatol. 1995;133:490-491.
12. Retief CR, Malkinson FD. Nitrofurantoin-associated
Sweet's syndrome. Cutis. 1999;63:177-179.
13. Thibaut MJ, Billick RC, Srolovitz H. Minocycline-
induced Sweet's syndrome. J Am Acad Dermatol.
14. Walker DC, Cohen PR. Trimethoprim-sulfamethoxazole–
associated acute febrile neutrophilic
dermatosis: case report and review of drug-induced
Sweet's syndrome. J Am Acad Dermatol. 1996;34:
15. Prevost-Blank PL, Shwayder TA. Sweet's syndrome
secondary to granulocyte colony-stimulating
factor. J Am Acad Dermatol. 1996;35:995-997.
16. Su WP, Liu HN. Diagnostic criteria for Sweet's
syndrome. Cutis. 1986;37:167-174.
17. von den Driesch P, Gomez RS, Kiesewetter F,
Hornstein OP. Sweet's syndrome: clinical spectrum
and associated conditions. Cutis. 1989;44:193-200.