Sweet Syndrome

This lovely picture was your clue for Case 4:

Sweets syndrome is an unusual condition characterised by:

1. Neutrophilic leucocytosis
2. tender erythematous, well-demarcated papules and plaques
3. fever
4. Arthralgia

The clinical differential diagnosis includes pyoderma gangrenosum, infection, erythema multiforme, adverse drug reactions, and urticaria.

Although this may occur de novo it should be considered a cutaneous marker of systemic disease as 50% of cases are associated with other conditions, particularly rheumatological disorders and haematological cancers including AML. The lesions may precede systemic disease by many months however.GCSF can also cause sweet syndrome.

Treatment for Sweet syndrome is corticosteroids (of course it is, we’re haematologists!) and will usually lead to an improvement in symptoms within 72 hours; steroids are then tapered over the following 6 weeks. A third of patients will have recurrent episodes.