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Review
. 2022 Nov;63(4):e356-e359.
doi: 10.1111/ajd.13897. Epub 2022 Jul 22.

A striking presentation of pustular Sweet syndrome induced by trimethoprim-sulfamethoxazole

C Yoonhee Ryder  1 , Natalie H Matthews  2 , Lori Lowe  2   3 , Frank Wang  2
Affiliations
Review

A striking presentation of pustular Sweet syndrome induced by trimethoprim-sulfamethoxazole

C Yoonhee Ryder et al. Australas J Dermatol. 2022 Nov.

Abstract

We describe a strikingly robust presentation of trimethoprim-sulfamethoxazole (TMP-SMX)-induced pustular Sweet syndrome and discuss how to distinguish it from iododerma and other neutrophil-rich conditions. A review of the literature indicates that TMP-SMX-induced Sweet syndrome (SS) may have higher rates of neutrophilia and greater ocular, mucosal, and musculoskeletal involvement compared to SS from other drugs. Recognizing these features and identifying the offending agent are critical for correctly diagnosing TMP-SMX-induced SS in a timely manner.

Keywords: Sweet syndrome; drug eruptions; drug hypersensitivity; neutrophils; potassium iodide; trimethoprim, sulfamethoxazole drug combination.

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Conflict of interest statement

The authors have no conflict of interests to declare.

Figures

FIGURE 1
FIGURE 1
Clinical presentation of a 53‐year‐old male with trimethoprim‐sulfamethoxazole‐induced pustular Sweet syndrome. (a) Clusters of pus‐filled, edematous papules and nodules with central crusting, imparting a targetoid appearance, especially on the face. (b) Coalescing pustules on the palate. (c) Yellow conjunctival drainage. (d) A square‐shaped erythematous plaque studded with pustules on the abdomen, consistent with pathergy from an adhesive bandage.
FIGURE 2
FIGURE 2
Histological findings in trimethoprim‐sulfamethoxazole‐induced pustular Sweet syndrome. A biopsy of lesional skin on the face demonstrated (a) large follicularly based pustules (haematoxylin–eosin, original magnification 100×) and (b) a diffuse, dense dermal neutrophilic infiltrate (haematoxylin–eosin, original magnification 100×).
See this image and copyright information in PMC

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