TY - JOUR
T1 - Giant cellulitis-like Sweet syndrome
T2 - An underrecognized clinical variant mimicking skin and soft tissue infection
AU - Mitaka, Hayato
AU - Jammal, Rita
AU - Saabiye, Joseph
AU - Yancovitz, Stanley
AU - Perlman, David C.
N1 - Publisher Copyright:
© 2020 The Author(s)
PY - 2020
Y1 - 2020
N2 - A new clinical variant of Sweet syndrome, called giant cellulitis-like Sweet syndrome, can masquerade as cellulitis because the patients present with an acute onset of large erythematous plaques, fever, and leukocytosis with neutrophil predominance. This case describes a 90-year-old female with a history of invasive ductal carcinoma of the breast who presented with 3 days of erythema of the right chest and right leg. Physical examination was notable for well-demarcated, blanching erythematous rashes involving the right chest and right lower extremity. Laboratory data was notable for neutrophilic leukocytosis. A clinical diagnosis of cellulitis was made initially, and intravenous cefazolin was initiated. The rash had only partially improved with antibiotics. Skin biopsy revealed a dense neutrophilic infiltrate, which was consistent with Sweet syndrome. Based on the widespread plaques, this case was considered a “giant cellulitis-like” variant of Sweet syndrome. Clinicians should have a high index of suspicion for Sweet syndrome when assessing a patient with fever, neutrophilia and erythematous skin plaques atypical of cellulitis because this condition does not respond to antimicrobial therapy and requires systemic glucocorticoid therapy.
AB - A new clinical variant of Sweet syndrome, called giant cellulitis-like Sweet syndrome, can masquerade as cellulitis because the patients present with an acute onset of large erythematous plaques, fever, and leukocytosis with neutrophil predominance. This case describes a 90-year-old female with a history of invasive ductal carcinoma of the breast who presented with 3 days of erythema of the right chest and right leg. Physical examination was notable for well-demarcated, blanching erythematous rashes involving the right chest and right lower extremity. Laboratory data was notable for neutrophilic leukocytosis. A clinical diagnosis of cellulitis was made initially, and intravenous cefazolin was initiated. The rash had only partially improved with antibiotics. Skin biopsy revealed a dense neutrophilic infiltrate, which was consistent with Sweet syndrome. Based on the widespread plaques, this case was considered a “giant cellulitis-like” variant of Sweet syndrome. Clinicians should have a high index of suspicion for Sweet syndrome when assessing a patient with fever, neutrophilia and erythematous skin plaques atypical of cellulitis because this condition does not respond to antimicrobial therapy and requires systemic glucocorticoid therapy.
KW - Acute febrile neutrophilic dermatosis
KW - Cellulitis
KW - Erysipelas
KW - Giant cellulitis-like sweet syndrome
KW - Skin and soft tissue infection
UR - http://www.scopus.com/inward/record.url?scp=85086580742&partnerID=8YFLogxK
U2 - 10.1016/j.idcr.2020.e00874
DO - 10.1016/j.idcr.2020.e00874
M3 - Article
AN - SCOPUS:85086580742
SN - 2214-2509
VL - 21
JO - IDCases
JF - IDCases
M1 - e00874
ER -