Sweet's syndrome with pulmonary involvement

Abstract

Sweet's syndrome is an acute febrile neutrophilic dermatosis with classical clinical features. Systemic manifestations in Sweet's syndrome including fever, arthralgia, myalgia and ocular involvement are common. Pulmonary involvement is a rare manifestation that has been reported previously in 34 cases and can be fatal if left untreated. We report a striking case of Sweet's syndrome with respiratory failure secondary to bilateral pulmonary interstitial infiltrates, which rapidly responded to intravenous corticosteroid therapy. This case is an important reminder of the systemic manifestations of Sweet's syndrome and highlights the value of collaboration between different medical specialities to optimise patient management and outcomes.

Keywords: dermatology; haematology (incl blood transfusion); respiratory medicine.

Figure 1

(A) Multiple tender purpuric annular plaques on back at initial presentation. (B) Several weeks later, after initial clearance of plaques seen as hyperpigmented scars, recurrence of painful annular plaques on upper arms and back. (C) Recurrent annular plaque on upper arm with prominent vesiculation. (D) Recurrent lesions on mid chest.

Figure 2

Histological examination of skin biopsy from left arm showing features of severe Sweet’s syndrome. (A, B) On low magnification, there is a dense superficial and mid dermal infiltrate and massive subepithelial oedema imparting a pseudobullous appearance. (C) On medium magnification, collection of purpura with dense inflammation in the dermis can be seen. (D) On high magnification, the dermal infiltrate is composed of neutrophils with marked red cell extravasation. There are prominent blood vessels with oedema of their walls but no areas of fibrinoid necrosis. H&E, original magnification (A, B) 10× (C) 20× and (D) 40×.

Figure 3

(A) Chest X-ray pretreatment showing bilateral upper and mid zone consolidation. (B) High-resolution CT chest showing bilateral upper lobe ground-glass opacities and interstitial thickening. (C) Chest X-ray 5 days after treatment with intravenous methylprednisolone showing almost complete clearing of bilateral infiltrates.