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Sudden-Onset, Discrete, Painful Lesions in a 39-Year-Old Man

Sudden-Onset, Discrete, Painful Lesions in a 39-Year-Old Man

Figure
Figure A
Figure
Figure B

A 39-year-old man sought evaluation of
newly erupted skin lesions on his arms.
Ten days earlier he had fallen on his
forearms, but no bruises appeared at
that time.

The multiple discrete, small, red,
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
fatigued.

The patient was in no acute distress.
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
to palpation.

The chest film was unremarkable.
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
polymorphonuclear infiltrate,
which confirmed the suspected diagnosis
of Sweet syndrome.

A tapering course of an oral corticosteroid
was prescribed; the disease
resolved in 6 weeks.

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:

  • Fever.
  • Peripheral neutrophilia.
  • Raised, painful plaques on the
    limbs, face, and neck.
  • Histologically dense dermal infiltration
    with mature polymorphonuclear
    cells.

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

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