Thread by @BIDMC_IDFellows

1/
40F with myelodysplastic syndrome presents with fever, fatigue, and new rash. There are new tender lesions on left arm and right leg, an example below.

Labs: WBC 15, CRP 150

Biopsy is done, what do you expect to find? Poll next!
#IDTwitter #IDMedEd

2/
What do you expect to find on biopsy histopath?

3/
Final dx = Sweet syndrome! The ddx though is quite broad and often includes cutaneous infections (bacterial, fungal, mycobact), pyoderma gangrenosum, drug reaction to name a few

4/
@GPetranyi did a quick review for case conference this week:

⭐️Sweet syndrome = acute febrile neutrophilic dermatosis
▪️Fever
▪️Abrupt onset of painful erythematous plaques and nodules
▪️Bx histopath: Dense neutrophilic infiltrate
▪️Labs: ⬆️ESR/CRP, neutrophilia

5/
Sweet synd has multiple associations:
▪️Malignancy
▪️Infections (usu 1-3 wks after)
▪️IBD
▪️Pregnancy
▪️Drug-induced

6/
Pathergy = exaggerated lesions develop at sites of minor cutaneous injury, such as bump, bruise, needlestick.

Can occur with Sweet syndrome, pyoderma gangrenosum, and Behcets >> and these would all have neutrophilic dermatosis on skin bx

7/
Here is an interesting case of Sweet syndrome and syphilis in HIV-infected pt from @BIDMC_IDFellows, image below 👇
pubmed.ncbi.nlm.nih.gov/18398981/

Check out a good review of Sweet syndrome here: pubmed.ncbi.nlm.nih.gov/17655751/