F 28 with fever, leukocytosis and tender erythematous papular rash on left chest.

Deba P Sarma, MD Omaha

F 28, left chest.

Diagnosis: Sweets syndrome (Acute febrile neutrophilic dermatosis) Comment: Sweet's syndrome (acute febrile neutrophilic dermatosis) is characterized by fever, leukocytosis, and tender, erythematous, welldemarcated papules and plaques which show dense neutrophilic infiltrates on histologic examination.

Epidermis is normal, dense neutrophilic infiltration in dermis, no fibrinoid necrosis of vessels or leukocytoclastic vasculitis.

Although it may occur in the absence of other known disease, Sweet's syndrome is often associated with hematologic disease (including leukemia), and immunologic disease (rheumatoid arthritis, inflammatory bowel disease).

Clinical associations:

Idiopathic/Classic (70%): F>M, 50s.

Associated with hematopoietic malignancy (leukemia) or other solid malignant tumors.

Associated with immunologic diseases (relapsing polychondritis, rheumatoid arthritis, dermatomyositis, inflammatory bowel disease).