Sweet's syndrome in an infant – report of a rare case

Abstract

A 35‐day‐old baby girl presented with a history of sudden onset of skin lesions of 4 days’ duration. The skin lesions initially appeared on the cheeks, but progressed to involve the trunk and limbss within 4 days. There was a history of upper respiratory tract infection 10 days prior to the onset of the skin lesions. The skin lesions were associated with fever. There was no history or symptoms suggestive of systemic involvement. The child was not on any drugs prior to the onset of the skin lesions. On examination, the child was febrile with a temperature of 100 °F and a pulse rate of 120 beats/min, and weighed 3.8 kg. Cutaneous examination revealed multiple, erythematous, nodular lesions on the face (Fig. 1). A few large bullous lesions were present on the thighs and gluteal region. Multiple tender nodules and a few annular lesions with well‐defined discrete papules at the margins and central erythema were also seen on the trunk and limbs. There was no involvement of the mucous membranes. Systemic examination was within normal limits. Figure 1  Face showing erythematous nodular lesions The investigations revealed a hemoglobin of 7.2 g%, a total count of 30,000 cells/mm3 with a differential count of 79% neutrophils, and an erythrocyte sedimentation rate of 50 mm at 1 h. Urine examination, USG, and pus culture were normal. Human immunodeficiency virus (HIV) screening in the baby and mother was negative. The histopathologic section revealed a dense inflammatory cell infiltrate involving the epidermis and upper dermis, composed mainly of neutrophils. The epidermis also showed edema and spongiotic vesicles. The inflammatory cell infiltrate was distributed around small blood vessels, as well as the entire upper dermal tissue, together with leukocytoclasis (Fig. 2). 2 Histopathology of a nodule showing perivascular and upper dermal neutrophilic infiltrate with leukocytoclasis and spongiosis of the epidermis (× 40) The baby was treated with oral prednisolone, at a dose of 1 mg/kg body weight, and oral potassium iodide (100%), five drops, three times daily. With this regimen, the skin lesions regressed in 4 weeks. Steroids were gradually tapered and oral potassium iodide was continued for four more weeks and then stopped. The lesions resolved with secondary cutis laxa. There was no relapse at the end of a follow‐up period of 12 months.

A First Case of Trimethoprim‐Sulfamethoxazole Induced Sweet’s Syndrome in a Child

“…Trimethoprim‐sulfamethoxazole induced SS is very rare and our case is to our knowledge the first case occurring in a child, the two previous reported cases have occurred in adult patients (in 1986 and 1996) (1,2). Indeed, SS is very uncommon in children (6–8) and exceptional in infants (9) and newborns (10), making our report very original. The use of trimethoprim and sulfamethoxazole is usually safe in children.…”

Sweet's syndrome from an Indian perspective: a report of four cases and review of the literature

“…Another patient with acute myeloid leukemia complicated by Pneumocystis carinii infection succumbed to his illness despite treatment with systemic prednisolone and cotrimoxazole. Skin lesions resolved with secondary cutis laxa in an infant patient 5 . The addition of oral potassium iodide in one and dapsone in two of the new patients had a corticosteroid‐sparing effect.…”

“…The disease occurs worldwide without any racial predilection, and is not frequently reported in India. A PubMed and IndMed search revealed only 12 cases reported between 1985 and 2002 3–14 . In this article, four more new patients with SS are reported and the literature on Indian cases is reviewed.…”

Management of neutrophilic dermatoses

“…Several small series and case reports have demonstrated efficacy both as a monotherapy and a steroid-sparing agent at a dosage of 900 mg/day (14,17,(19)(20)(21). Potassium iodide appears to have a similar mechanism of action as dapsone in interfering with neutrophil chemotaxis and function.…”