Sweet's Syndrome: One Disease, Multiple Faces

Case 1 A man, aged 48 years, with a history of myelodysplastic syndrome, post-decitabine chemotherapy was admitted with a fever, skin rash, and pancytopenia. Physical examination showed multiple painless, non-itchy, erythematous, maculopapular skin lesions on the dorsum of both hands (figure Broad spectrum antibiotics, antifungals, and granulocyte colony-stimulating factor (G-CSF) therapy were started. The septic workup came back negative, yet the patient continued having low-grade fever with new skin lesions. Skin biopsy revealed diffuse dermal neutrophilic infiltrate (figure Prednisone (1mg/kg/day) was started and antibiotics were de-escalated. The skin lesions regressed, and the fever resolved in two days. Triggering factors were thought to be decitabine, myelodysplastic syndrome, and G-CSF therapy. He was discharged on oral prednisone.