Giant cellulitis-like Sweet Syndrome, a new variant of neutrophilic dermatosis

Surovy, Andre M.; Pelivani, Nedzmidin; Hegyi, Ivan; Buettiker, Urs; Beltraminelli, Helmut; Borradori, Luca (2013). Giant cellulitis-like Sweet Syndrome, a new variant of neutrophilic dermatosis. JAMA dermatology, 149(1), pp. 79-83. American Medical Association 10.1001/2013.jamadermatol.548

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BACKGROUND

Neutrophilic dermatoses comprise a wide spectrum of inflammatory diseases with overlapping features characterized histologically by the presence of an aseptic neutrophilic infiltrate in the epidermis, dermis, and/or hypodermis and are often associated with systemic inflammatory and neoplastic disorders.

OBSERVATIONS

We describe 3 patients with an unusual neutrophilic dermatosis characterized by relapsing episodes of fever, widespread infiltrated plaques with bullous appearance, and variable involvement of the arms, legs, abdomen, and/or trunk. Light microscopy studies showed marked edema of the papillary dermis with an inflammatory infiltrate consisting mainly of mature neutrophils. All 3 patients were morbidly obese, and workup revealed underlying cancer in 2 cases: myeloma and breast carcinoma. Management of the underlying disease resulted in long-term remission of the skin disease.

CONCLUSIONS

The clinicopathologic features in our 3 cases best correspond to a widespread giant cellulitis-like form of Sweet syndrome. Knowledge of this newly observed unusual variant of Sweet syndrome within the broad spectrum of neutrophilic diseases is important for its prompt and proper management.

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