Sweet syndrome presents with severe SIRS

MAJED K, ZAOUCHE KH, MAGHRAOUI H, BACCOUCHE R, HAMOUDA CH, FALFOUL N. Sweet syndrome presents with severe SIRS. Med Emergency, MJEM 2018; 26:19-21.

DOI 10.26738/MJEM.2017/mjem26.2018/MK.CRE.220217

Key words: SIRS, skin disorder, sweet syndrome
  • Authors’ affiliation
  • Article history / info
  • Conflict of interest statement
Correspondent author: Kamel MAJED, MD

Emergency medicine department, Rabta teaching hospital,

Tunis 1007 Tunis, Tunisia

mkmel78@yahoo.fr

Majed K, MD, Zaouche Kh, MD, Maghraoui H, MD, Baccouche R, MD, Hamouda Ch, PhD, Falfoul N, PhD

Emergency medicine department, Rabta teaching hospital, Tunis, Tunisia

Category: Case report

Received: Dec. 14, 2016

Revised: Feb. 01, 2017

Accepted: Feb. 22, 2017

There is no conflict of interest to declare

ABSTRACT

Introduction: Skin disorders are common in emergency department especially when associated with fever. Twenty five to forty percent are related to a decompensation of a preexisting skin disease [1]. In 1964, Sweet describes a “strange eruption” which is immunologically mediated and since that date the dermatitis bears his name [2]. In the emergency department, the diagnosis of this pathology may be difficult especially when the presentation is severe or associated with fever since it face the physician to a therapeutic dilemma: giving antibiotics or steroids.

Case presentation: A 43 years old man with no past medical history was transported to the emergency department by the mobile emergency service with a chief complaint of weakness and fever associated with a disseminated skin eruption. He was conscious but very weak and he has fever about 38.5°C. Systolic blood pressure/diastolic blood pressure was about 90/60 mmHg and heart rate about 96 per minute. Initially he was managed as severe septic syndrome since we found nitrites in urine sample associated with systemic inflammatory response syndrome (SIRS). A PCT was performed and the amount was less than 0.5 ng.mL-1 so we performed a skin biopsy which showed a neutrophilic infiltration consistent with Sweet syndrom. The patient was given steroids and had rapid improvement of his complaints.

Conclusion: Sweet syndrome is a possible diagnostic in patient with skin eruption and non infectious SIRS in the emergency department

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