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Case Reports
. 2020 Sep 9;12(9):e10330.
doi: 10.7759/cureus.10330.

Sweet Syndrome in an Elderly Man With Well-Controlled Human Immunodeficiency Virus

Steven M Mudroch  1   2 , Craig Rohan  3   2   4 , Nicholas G Conger  5   2   4 , David A Lindholm  5   2   4
Affiliations
Case Reports

Sweet Syndrome in an Elderly Man With Well-Controlled Human Immunodeficiency Virus

Steven M Mudroch et al. Cureus. .

Abstract

Acute febrile neutrophilic dermatosis, or Sweet syndrome, is a rare disorder associated with medications, underlying malignancy, or systemic inflammatory conditions. We present the case of a 71-year-old male living with well-controlled human immunodeficiency virus (HIV) on antiretroviral therapy, who presented with multiple painful, pseudo-vesicular, almost-necrotic appearing papules on his bilateral palms in the setting of constitutional symptoms and altered mental status. Biopsy of his palmar lesions revealed a dense, diffuse, dermal neutrophilic infiltrate consistent with Sweet syndrome. Infectious, rheumatologic, and oncologic work-up was negative. He was treated initially with intravenous immunoglobulin, prednisone, and dapsone; and he was continued on suppressive dapsone. He responded well clinically, but he relapsed multiple times in the setting of medication non-adherence before his ultimate diagnosis with sarcoidosis. A review of the literature of persons living with HIV and diagnosed with Sweet syndrome reveals no clear clinical association between the two despite plausible pathologic mechanisms. Patients living with HIV who are diagnosed with Sweet syndrome should be evaluated thoroughly for potential etiologies; the search for the underlying etiology of Sweet syndrome should go beyond their diagnosis of HIV.

Keywords: acute febrile neutrophilic dermatosis; hiv; sweet syndrome.

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Conflict of interest statement

Copyright statement: Some authors are employees of the U.S. Government. This work was prepared as part of their official duties. Title 17 U.S.C. 105 provides that ‘Copyright protection under this title is not available for any work of the United States Government.’ Title 17 U.S.C. 101 defines a United States Government work as a work prepared by a military service member or employee of the United States Government as part of that person’s official duties. Disclaimer: The contents of this publication are the sole responsibility of the author(s) and do not necessarily reflect the views, opinions, or policies of Uniformed Services University of the Health Sciences (USUHS), the Department of Defense (DoD), the Departments of the Air Force, or Wright-Patterson Medical Center. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. Government.

Figures

Figure 1
Figure 1. Initial clinical presentation and biopsy results.
(A) Right and (B) left palms demonstrating scattered painful, pseudo-vesicular, almost-necrotic-appearing papules on his bilateral palms [arrows]. (C) Dense, diffuse, dermal neutrophilic infiltrate on biopsy from one of his palmar lesions. No features of vasculitis were identified.
Figure 2
Figure 2. Follow-up clinical presentation.
Interval improvement of initial palmar lesions [arrows] four weeks after initiation of treatment with IVIG, prednisone, and dapsone. IVIG: intravenous immunoglobulin.
See this image and copyright information in PMC

References

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