Abstract

Background: Sweet’s Syndrome, also known as acute febrile neutrophilic dermatosis, is a rare inflammatory skin disorder that presents as a rapid onset of tender, inflammatory lesions, which usually appear on the arms, face, and neck. It is histologically characterized by a neutrophilic infiltrate in the dermis with karyorrhexis and massive papillary dermal edema. Sweet’s is subdivided into three classifications based on etiology: classical, malignancy-associated, and drug-induced.

Case Presentation: We present the case of a 55 year old African American woman with a past medical history of smoldering multiple myeloma and hepatitis C who presented to the emergency department with widespread tender bullous lesions on the extremities, trunk, inguinal area, and vulva, along with accompanying polyarthritis. The patient was treated empirically with intravenous methylprednisolone for suspected autoimmune disease following rule out of infectious etiology and vasculitis. Biopsies of the lesions on subsequent hospitalization demonstrated neutrophilic infiltrate of the dermis, and the patient was diagnosed with Sweet’s Syndrome.

Conclusion: It is unknown whether this patient's Sweet’s Syndrome was secondary to her smoldering multiple myeloma, hepatitis C, or idiopathic. We believe that smoldering multiple myeloma was the likely underlying culprit given the link between blood malignancies and Sweet’s Syndrome, the widespread presentation of the lesions, and similar presentations reported in cases of multiple myeloma. Based on our case study, we recommend patients diagnosed with Sweet’s Syndrome receive appropriate workup for blood malignancies and hepatitis C.

Keywords: Sweet’s Syndrome; Smoldering Multiple Myeloma; Hepatitis C

References

1. American Cancer Society. “Tests to Find Multiple Myeloma” (2019).
2. Bayer-Garner IB., et al. “Sweet syndrome in multiple myeloma: a series of six cases”. Journal of Cutaneous Pathology4 (2003): 261-264.
3. Belhadjali H., et al. “Sweet’s syndrome associated with multiple myeloma”. Acta Dermato-Venereologica 1 (2008): 31-33.
4. Cleveland Clinic. “Sweet Syndrome” (2019).
5. Coelho JF., et al. “Neutrophilic dermatosis of the dorsal hands associated with chronic hepatitis C virus infection”. Indian Journal of Dermatology, Venereology, and Leprology5 (2008): 478-480.
6. Cohen PR. “Sweets syndrome - a comprehensive review of acute febrile neutrophilic dermatosis”. Orphanet Journal of Rare Diseases1 (2007): 34.
7. Fauconnier SA., et al. “Neutrophilic dermatosis of the dorsal hands with multiple myeloma”. Joint Bone Spine2 (2016): 227.
8. Gurnari C., et al. “Recurrent Sweets syndrome in a patient with multiple myeloma”. Clinical Case Reports10 (2018): 1958-1960.
9. Hallberg P., et al. “Acute pancreatitis following medical abortion: Case report”. BMC Womens Health1 (2004): 1.
10. Khalid A. “Sweet's syndrome with multiple myeloma”. Journal of Applied Hematology3 (2014): 69-70.
11. Merola MD. “Sweet syndrome (acute febrile neutrophilic dermatosis): Pathogenesis, clinical manifestations, and diagnosis”. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc (2019).
12. “Sweet Syndrome” (1987).
13. Sweet RB. “An acute febrile neutrophilic dermatosis”. British Journal of Dermatology 76 (1964): 349-356.
14. Vadde R and Schmidt FJ. “Immunoglobulins: Reference Range, Interpretation, Collection and Panels” (2013).

Citation

Citation: Mark Obri., et al. “Recurrent Sweet’s Syndrome in a Case of Smoldering Multiple Myeloma and Chronic Hepatitis C". Acta Scientific Medical Sciences 4.7 (2020): 03-07.

Copyright

Copyright: © 2020 Mark Obri., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.