Sweet Syndrome in a Patient with Acute Leukemia on Azacitidine and Venetoclax Treatment

Abstract

Introduction Sweet syndrome, also called acute febrile neutrophilic dermatosis, is a rare disorder characterized by skin lesions accompanied by high fever and elevated inflammatory markers. Case Presentation In January 2023, a 73-year-old Caucasian male was diagnosed with acute myeloblastic leukemia and subsequently chemotherapy with azacitidine and venetoclax was initiated. One week after the second round of chemotherapy with azacitidine, the patient developed a fever of 39˚C. Physical examination revealed purple plaques on the skin of the head, neck, and arms associated with pain but not itching. Initially, the plaques appeared at the site of the subcutaneous azacitidine injection (left upper extremity) and then began to spread. The infectious diseases consultation established the diagnosis of multiple abscesses. Antibiotic therapy was initiated with meropenemum and linezolidum, and later colistin was associated, but the skin lesions and the patient’s condition worsened. A dermatology consultation was performed, which established the diagnosis of Sweet syndrome, and subsequently corticosteroid therapy was started. The skin lesions started to improve after 3 days. Conclusions Sweet syndrome is a rare condition that is difficult to diagnose because of the wide spectrum of differential diagnoses.