Skin Lesions and Neutropenic Fever in a 69-Year-Old Woman

Cameron Nichols, MD; Fnu Nutan, MD


June 26, 2020

The most effective treatment for Sweet syndrome is oral prednisone (0.5-1 mg/kg/day), tapered over a 4- to 6-week period.[3] In patients who have had recurrence, tapering prednisone over 2-3 months may be necessary. Higher doses can be used for systemic involvement or severe disease.

Antibiotics are not effective for this syndrome, but ruling out infection is important because Sweet syndrome can look very similar. Many patients with Sweet syndrome are immunosuppressed secondary to hematologic cancer or treatments for their cancer, which adds to the importance of ruling out infection. Some alternative therapies that have been used include topical corticosteroids (for limited disease), oral dapsone, colchicine, and potassium iodide.[1]

Drug-induced Sweet syndrome can appear similar to classic Sweet syndrome; however, a temporal relationship with initiation of medication is required. The most commonly implicated drugs include granulocyte-colony stimulating factors, azathioprine, and all-trans retinoic acid.[4] Lesions typically resolve after drug withdrawal.

The patient in this case started taking oral prednisone (1 mg/kg), with plans for a 4-6 week taper. After about 3 weeks of treatment, she demonstrated significant improvement. The dose was gradually tapered.


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