SHM Converge Scientific Abstract ePoster Gallery-Sweet Syndrome in Refractory Aml: A Case of Acute Febrile Neutrophilic Dermatosis in a Neutropenic Patient

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This case describes a 45-year-old man with relapsed, refractory acute myeloid leukemia (AML) who developed Sweet syndrome while hospitalized for neutropenic fever. He had a history of stem cell transplant and possible skin graft-versus-host disease, and was receiving ruxolitinib and prednisone. On admission, he was febrile, profoundly pancytopenic, and had a large erythematous right leg lesion initially thought to be cellulitis, plus left axillary lymphadenopathy. Blood cultures remained negative, and broad-spectrum antibiotics and antifungal coverage were started.<br /><br />Over the next several days, the leg lesion darkened and enlarged, and he developed multiple new pruritic erythematous macules and plaques on the face, scalp, neck, shoulders, and limbs. Because of concern for angioinvasive fungal infection, additional antifungals were added. Skin biopsy showed a mixed inflammatory infiltrate with many neutrophils, lymphocytes, and histiocytes; culture data were negative. Karius testing, beta-D-glucan (Fungitell), and galactomannan were also negative, making invasive fungal disease less likely. With infection less likely, dexamethasone was started, and some lesions improved.<br /><br />The patient met diagnostic criteria for Sweet syndrome: acute painful erythematous plaques/nodules, fever, neutrophilic histology, and association with malignancy. Sweet syndrome is a rare, noninfectious neutrophilic dermatosis most often linked to hematologic malignancies such as AML. Although mortality is usually low, it is higher in malignancy-associated cases, and death is often related to the underlying cancer rather than the syndrome itself. This case emphasizes that in cancer patients with new skin lesions, Sweet syndrome should remain high on the differential, and early biopsy can help distinguish it from infection and allow timely steroid treatment.

Asset Subtitle

Elizabeth Bixler

Meta Tag

Author List Elizabeth Bixler, Kia Gallagher

Category Clinical Vignettes

Concept Sweet Syndrome

Concept Corticosteroid

Concept Hematologic Malignancy

Concept Neutropenia

Concept Skin Biopsy

Distinguished Non-Finalist

Presenter Organization University of California, San Diego

Presenting Author Elizabeth Bixler

Track Adult

Keywords

Sweet syndrome

acute myeloid leukemia

neutropenic fever

hematologic malignancy

skin biopsy

neutrophilic dermatosis

stem cell transplant

cellulitis mimic

fungal infection differential

corticosteroid treatment

Sweet Syndrome

Corticosteroid

Hematologic Malignancy

Neutropenia

Skin Biopsy