An uncommon culprit of neutropenic fever: a case of Sweet syndrome following induction therapy for acute myeloid leukemia

Ahmed Alderazi, Alec B. Rezigh


Sweet syndrome (SS) is a rare inflammatory disorder characterized by the rapid onset of a characteristically tender rash, fever, and other systemic symptoms. These manifestations are often mistaken for an infection that is not responding to antimicrobials, especially in immunocompromised hosts. We present the case of a 44-year-old woman who developed SS following induction chemotherapy for newly diagnosed acute myeloid leukemia (AML). She exhibited a painful rash on the anterior chest, which spread centrifugally, along with neutropenic fever unresponsive to broad-spectrum antimicrobials. Biopsy of the rash revealed a dense neutrophilic infiltrate within the dermis, confirming the diagnosis of SS. The patient was subsequently treated with systemic steroids with prompt resolution of fevers and improvement of her rash. This case highlights that SS can manifest with a robust neutrophilic infiltrate, even in the context of neutropenia stemming from chemotherapy. SS serves as a crucial consideration in hematologic malignancies, particularly AML, when patients present with fever and cutaneous eruptions. Prompt recognition followed by systemic steroid therapy often leads to symptom resolution.


Sweet syndrome; neutropenic fever; acute myeloid leukemia; chemotherapy

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Heath MS, Ortega-Loayza AG. Insights Into the Pathogenesis of Sweet's Syndrome. Front Immunol. 2019;10:414. doi: 10.3389/fimmu.2019.00414. PMID: 30930894; PMCID: PMC6424218.

Kemmett D, Hunter JA. Sweet's syndrome: a clinicopathologic review of twenty-nine cases. J Am Acad Dermatol. 1990;23(3 Pt 1):503-507. doi: 10.1016/0190-9622(90)70250-l. PMID: 2212153.

Raza S, Kirkland RS, Patel AA, Shortridge JR, Freter C. Insight into Sweet's syndrome and associated-malignancy: a review of the current literature. Int J Oncol. 2013;42(5):1516-1522. doi: 10.3892/ijo.2013.1874. PMID: 23546524.

Cohen PR, Kurzrock R. Sweet's syndrome and cancer. Clin Dermatol. 1993;11(1):149-157. doi: 10.1016/0738-081x(93)90112-p. PMID: 8339190.

Cohen PR. Sweet's syndrome--a comprehensive review of an acute febrile neutrophilic dermatosis. Orphanet J Rare Dis. 2007;2:34. doi: 10.1186/1750-1172-2-34. PMID: 17655751; PMCID: PMC1963326.

Villarreal-Villarreal CD, Ocampo-Candiani J, Villarreal-Martínez A. Sweet Syndrome: A Review and Update. Actas Dermosifiliogr. 2016;107(5):369-378. English, Spanish. doi: 10.1016/ PMID: 26826881.

Kazmi SM, Pemmaraju N, Patel KP, et al. Characteristics of Sweet Syndrome in patients with acute myeloid leukemia. Clin Lymphoma Myeloma Leuk. 2015;15(6):358-363. doi: 10.1016/j.clml.2014.12.009. PMID: 25630528; PMCID: PMC4457594.

Joshi TP, Friske SK, Hsiou DA, Duvic M. New Practical Aspects of Sweet Syndrome. Am J Clin Dermatol. 2022;23(3):301-318. doi: 10.1007/s40257-022-00673-4. PMID: 35157247; PMCID: PMC8853033.

von den Driesch P. Sweet's syndrome (acute febrile neutrophilic dermatosis). J Am Acad Dermatol. 1994;31(4):535-556; quiz 557-60. doi: 10.1016/s0190-9622(94)70215-2. PMID: 8089280.

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(5 Pt 2):918-923. doi: 10.1016/s0190-9622(96)90080-8. PMID: 8621829.

Cohen PR, Talpaz M, Kurzrock R. Malignancy-associated Sweet's syndrome: review of the world literature. J Clin Oncol. 1988;6(12):1887-1897. doi: 10.1200/JCO.1988.6.12.1887. PMID: 3058878.

Cohen PR, Kurzrock R. Sweet's syndrome: a review of current treatment options. Am J Clin Dermatol. 2002;3(2):117-31. doi: 10.2165/00128071-200203020-00005. PMID: 11893223.

Zheng S, Li S, Tang S, et al. Insights Into the Characteristics of Sweet Syndrome in Patients With and Without Hematologic Malignancy. Front Med (Lausanne). 2020;7:20. doi: 10.3389/fmed.2020.00020. PMID: 32133363; PMCID: PMC7039821.


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