PMC2847699_01
Clinicopathologic features of Sweet syndrome in our patient at diagnosis: (a) Photograph showing the purpuric patches and pustulovesicular lesions over the left leg and dorsum of foot at diagnosis. (b) Photograph showing the resolving skin lesions over the left leg and dorsum of foot at the time of writing the manuscript. (c) Low power H & E of skin showing diffuse infiltrate of dermis and superficial subcutis with neutrophils (arrow). There is incipient necrosis of the epidermis. Dimension bar (left lower corner) 250 microns. (d) High power H & E of skin:the arrow shows focal leukocytoclasis without vasculitis:dimension bar (left lower corner) 50 microns.
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fig1
On the next day of admission, pustulovesicular eruptions developed over her arms and purpuric patches over the left thigh, shin, and dorsum of her left foot (Figure 1(a)). A skin biopsy of a suppurative lesion on her left thigh showed a diffuse neutrophilic infiltrate within the mid to upper dermis, associated with early leukocytoclasis and absence of vasculitic changes (Figures 1(c) and 1(d)). Monthly dose of IVIG was administered and prednisolone could be slowly tailed off without worsening of her skin condition at the time of writing this paper 8 months after presentation (Figure 1(b)).
The effect of various pharmacotherapies on the absolute neutrophil count and temperature (each arrow represents a 21-gram-dose of IVIG).
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Intriguingly, both the fever and the neutrophilia responded promptly (Figure 2).