ID Fellows Cup Question 11

Correct Answer: Prednisone

This case describes Sweet’s Syndrome which is a neutrophillic dermatosis associated with hematologic malignancy. Treatment would include prednisone and it frequently responds well.

  • 80-90% of time fever is present
  • Lesions found more frequently on arms and torso.
  • Diagnosis confirmed by pathology demonstrating sub-epidermal edema (this explains the raised quality of lesions) and dense neutrophilic infiltrate.
  • Associations beyond heme malignancy include Crohn’s, infections (Y. enterolitica, S. Pyogenes, HIV) and drugs including trimethoprim-sulfamethaxole.

Distractor answer choices

  • Ruling out infection (and need for antimicrobials) in this immune-compromised patient is crucial and thus waiting on biopsy prudent, particularly before treating with steroids.
  • Neutropenia increases risk for gram-negatives, candida and mold disease among others. Skin manifestations of invasive infections are broad in this population.
  • Ecthyma gangrenosum (pictured below) is an important one to consider. However the longer duration of her illness, lack of systemic symptoms, and large number of lesions would point away from ecthyma or another process triggered by direct invasion of an infectious organism at tissue level.
Ecthyma gangrenosum. Image Credit: https://www.nejm.org/doi/full/10.1056/nejmicm1702302

https://pubmed.ncbi.nlm.nih.gov/17300237/

Author: Jeremey Walker at UAB

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This question was uploaded on 2/25/22

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