Three unusual cases of Sweet’s syndrome where skin lesions were the only symptom

Links checked on 3/04/17.

What are the symptoms of Sweet’s syndrome?

The main symptom of Sweet’s syndrome is skin lesions (Sweet’s lesions) that often appear as a sore or painful red/purple rash, but most people develop other symptoms too. These symptoms include:

  • Unexplained fever: normally 38 degrees centigrade or above. Slightly less likely to occur in patients who develop Sweet’s syndrome secondary to cancer and blood disorders.
  • Fatigue: a medical term that includes a number of different symptoms. It is not the same as ordinary tiredness, and occurs as a result of the inflammation in the body that Sweet’s syndrome causes. Therefore, the things that normally help when you are tired, e.g. getting some sleep, eating more healthily, or getting some fresh air, may help a little bit, but will not resolve the fatigue completely. Symptoms of fatigue can include tiredness or exhaustion – the kind that you can never seem to ‘shake-off’, and can be debilitating; poor concentration or memory (‘brain-fog’); flu-like symptoms; limb heaviness which can sometimes make every movement seem like a real effort.
  • Headache, and less commonly, migraine.
  • Joint pain (arthralgia) or joint pain and swelling (arthritis).
  • Muscle aches and pain (myalgia).
  • Eye problems, e.g. conjunctivitis, episcleritis, or iridocyclitis.
  • Occasionally mouth ulcers (aphthous-like ulcers), but this is a symptom more commonly associated with the similar condition Behcet’s syndrome.

Do some people only develop skin lesions?

Yes, but this is rare. Most people with Sweet’s syndrome develop other symptoms alongside their skin lesions.

Examples of Sweet’s syndrome where skin lesions are the only symptom.

Case 1.

This is a case of a 47-year-old women with Sweet’s syndrome who only developed skin lesions called plaques (raised purple/red areas) on her finger tips, palms of her hands and soles of her feet (Bubna et al, 2015). This is rare, as Sweet’s lesions are not normally confined to these areas. The plaques on the finger tips and palms of the hands also formed a symmetrical pattern. The patient did not have a fever or other symptoms of Sweet’s syndrome, but her white blood cell count, including neutrophil (a type of white blood cell) count, was raised. Biopsy (sample of a lesion) showed lots of neutrophils and no vasculitis (inflammation of the vessels). Both these findings were indicative of Sweet’s syndrome.

Case 2.

This is a rare case of a 45-year-old farmer from Nepal with Sweet’s syndrome who had suddenly developed skin lesions on his neck and forearms (Bubna and Rangarajan, 2015). Initally, the lesions were small, but grew in size over a period of 5 days. He did not have a fever or other symptoms of Sweet’s syndrome, but his white blood cell and neutrophil counts were raised.

The patient’s lesions appeared in a variety of different forms: papules (lumps/bumps) and plaques which are common in Sweet’s syndrome; highly unusual fleshy lesions with a central dent that looked like a navel (belly-button); fleshy lesions with a crust over a central dent. The lesions on his left arm were very similar to the lesions seen in the common viral infection, molluscum contagiosum, and developed in a symmetrical pattern. Biopsy of the lesions showed lots of neutrophils and no vasculitis.

Case 3.

This is a case of a 41-year-old man who developed Sweet’s syndrome secondary to upper respiratory tract infection (including tonsillitis) or the antibiotic amoxicillin (Volpe, 2016). He had a sore throat and dry cough on admission, probably caused by the respiratory infection. He did not have a fever or other symptoms of Sweet’s syndrome. Skin lesions had developed on his left hand, right forearm, and right side of his forehead. Most of these were  purple and painful. His white blood cell count, including neutrophil count, was raised. Erythrocyte sedimention rate (ESR) and C-reactive protein (CRP) – blood tests to show inflammation in the body – were normal. Biopsy of the lesions showed lots of neutrophils and no vasculitis.

References.

Bubna, A. and Rangarajan, S. (2015) Molluscoid Pseudovesicles: An Unusual Presentation of Sweet’s Syndrome. Indian Journal of Dermatology, Nov-Dec; 60(6): 636 (online).

Bubna, A., Veeraraghavan, M., Anandan, S. and Rangarajan, S. (2015) Palmoplantar pseudovesicles: an unusual presentation of sweet’s syndrome. Indian Journal of Dermatology;60:94-6 (online).

Volpe, M. (2016) Sweet Syndrome Associated with Upper Respiratory Infection and Amoxicillin Use. Cureus, Apr; 8(4): e568 (online).

Further information.

How is Sweet’s syndrome diagnosed?

Neutrophilic dermatosis of the hands: a localized, bullous variant.   

NHS Choices (2014) Molluscum contagiosum (online). Reviewed on 1/10/14, and accessed on 3/04/17.

© 2012-2017 Sweet’s Syndrome UK

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