Sweet syndrome associated with secondary nodular syphilis in an immunocompetent patient

Abstract

Sweet syndrome is an inflammatory disease characterized by fever, neutrophilia, papules and erythematous plaques, and a skin neutrophilic infiltrate. Syphilis has been reported among the infectious causes of Sweet syndrome. Syphilis can present atypical manifestations; a rare presentation is nodular syphilis, characterized by nodules with granulomas and plasma cells at histopathology. This case report presents a 20-year-old woman patient, with plaques and nodules, and systemic symptoms. The histopathological exam revealed both non-tuberculoid granulomas and a dense infiltration of polymorphonuclear neutrophils in the dermis. These findings, plus laboratory abnormalities, characteristic of both conditions, were conclusive for Sweet syndrome and nodular syphilis association.

New Practical Aspects of Sweet Syndrome

“…A 2020 Thai study of 88 patients with nontuberculous mycobacterial (NTM) infections reported the prevalence of SS to be 3.4%, and concluded SS to be the most common reactive dermatosis in NTM infections [120]. The incidence of SS in other bacterial infections is less well characterized, although SS has been reported in the setting of infection with Burkholderia pseudomallei [121], Erysipelothrix rhusiopathiae [122], Mycobacterium tuberculosis [123], and Treponema pallidum [124,125]. Viruses have also been reported in association with SS, with Hepatitis C [126], human immunodeficiency virus [127,128], and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [129][130][131] being recently reported as culprits.…”