Health Science University Antalya Training and Research Hospital, Emergency Medicine Department, Turkey.
Am J Emerg Med. 2019 Sep;37(9):1807.e1-1807.e3. doi: 10.1016/j.ajem.2019.06.012. Epub 2019 Jun 5.
Sweet's syndrome (SS), also known as acute febrile neutrophilic dermatosis, is a rare condition characterized by recurrent erythematous skin lesions. Skin lesions appear as papules, nodules and plaques located on the upper extremity, trunk, neck and face.
A 72-year-old male patient presented to the emergency department with a 10-day history of generalized rash, generalized muscle and joint pain and high fever. He had a history of upper respiratory tract infection. He presented with painful erythematous plaques on both lower and upper extremities and the trunk as well as serohemorrhagic bullous lesions on the feet. The laboratory results revealed WBC count of 20.6 × 10/mm (76.9% neutrophils), CRP (c-reactive protein) of 33 mg/L and erythrocyte sedimentation of 110/h. The patient was referred to a dermatologist with prediagnosis of SS due to the presence of typical painful skin lesions, high fever and neutrophilic leukocytosis. A systemic corticosteroid therapy was initiated. The diagnosis for SS was confirmed after the skin biopsy revealed the presence of dense dermal infiltrate of neutrophils and leukocytoclasis in the upper dermis. The patient responded rapidly to corticosteroids and the skin lesions improved.
We reported this case as it was a rare life-threatening dermatosis diagnosed in the emergency department, which is generally difficult to diagnose therein, and the skin lesions appeared on the lower extremities.
Sweet 综合征（SS），也称急性发热性嗜中性皮病，是一种罕见的疾病，其特征为反复出现红斑性皮损。皮损表现为位于上肢、躯干、颈部和面部的丘疹、结节和斑块。
一名 72 岁男性患者因全身皮疹、全身肌肉关节痛和高热 10 天就诊于急诊科。他有上呼吸道感染史。患者的下肢和上肢以及躯干均出现疼痛性红斑斑块，足部有浆液血性大疱性皮损。实验室结果显示白细胞计数为 20.6×10/mm（76.9%为中性粒细胞）、C 反应蛋白（CRP）为 33mg/L 和红细胞沉降率为 110/h。由于存在典型的疼痛性皮肤损伤、高热和中性粒细胞白细胞增多症，该患者被转诊至皮肤科医生，预诊断为 SS。给予全身皮质类固醇治疗。皮肤活检显示真皮内有密集的中性粒细胞浸润和真皮上部的白细胞碎裂，从而确诊为 SS。患者对皮质类固醇反应迅速，皮肤损伤改善。
我们报告了这例病例，因为它是一种罕见的危及生命的皮肤科疾病，在急诊科通常难以诊断，而且下肢出现了皮损。
