Drug-Induced Sweet‘s Syndrome

Excerpt

A 69-year-old man with ulcerative colitis presented with fever, fatigue, and rash. The patient reported onset of symptoms within 5 days of starting azathioprine. Physical examination revealed a fever of 39.5°C and a painful rash of erythematous plaques with pustules on bilateral elbows and neck (Fig. 1) and scattered macules on bilateral palms. The white blood cell count was 8000/mm³ with 96% neutrophils; the erythrocyte sedimentation rate was 60 mm/h. Biopsy of the elbow lesion revealed a dense dermal neutrophilic infiltrate, lack of perivascular inflammation, and papillary dermal edema consistent with Sweet’s syndrome (Fig. 2). Symptoms and rash rapidly resolved after discontinuing azathioprine.

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