Sweet Syndrome in an Elderly Man With Well-Controlled Human Immunodeficiency Virus

Abstract

Acute febrile neutrophilic dermatosis, or Sweet syndrome, is a rare disorder associated with medications, underlying malignancy, or systemic inflammatory conditions. We present the case of a 71-year-old male living with well-controlled human immunodeficiency virus (HIV) on antiretroviral therapy, who presented with multiple painful, pseudo-vesicular, almost-necrotic appearing papules on his bilateral palms in the setting of constitutional symptoms and altered mental status. Biopsy of his palmar lesions revealed a dense, diffuse, dermal neutrophilic infiltrate consistent with Sweet syndrome. Infectious, rheumatologic, and oncologic work-up was negative. He was treated initially with intravenous immunoglobulin, prednisone, and dapsone; and he was continued on suppressive dapsone. He responded well clinically, but he relapsed multiple times in the setting of medication non-adherence before his ultimate diagnosis with sarcoidosis. A review of the literature of persons living with HIV and diagnosed with Sweet syndrome reveals no clear clinical association between the two despite plausible pathologic mechanisms. Patients living with HIV who are diagnosed with Sweet syndrome should be evaluated thoroughly for potential etiologies; the search for the underlying etiology of Sweet syndrome should go beyond their diagnosis of HIV.

New Practical Aspects of Sweet Syndrome

“…The incidence of SS in other bacterial infections is less well characterized, although SS has been reported in the setting of infection with Burkholderia pseudomallei [121], Erysipelothrix rhusiopathiae [122], Mycobacterium tuberculosis [123], and Treponema pallidum [124,125]. Viruses have also been reported in association with SS, with Hepatitis C [126], human immunodeficiency virus [127,128], and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [129][130][131] being recently reported as culprits.…”

Síndrome de <i>Sweet</i> secundario a síndrome inflamatorio de reconstitución inmune: reporte de 2 casos

“…Mudroch et al realizaron una revisión de 17 casos de SS en personas que viven con VIH, encontrando una asociación con SIRI únicamente en el 25% de los casos, sin encontrar en el resto una clara relación entre el conteo de células CD4 o la carga viral, por lo cual el estado inmunológico, es decir, la reconstitución inmune temprana, podría no ser el única alteración involucrada en la fisiopatología del SS. Por otra parte, se presume que la alteración de la respuesta celular tipo 1 y 2, con liberación de citocinas, así como una posible reacción de hipersensibilidad a infecciones (en este caso el VIH), provoca activación y quimiotaxis de neutrófilos, que ocasiona un ambiente favorable para la fisiopatogenia del SS 11 . También se ha postulado que la glucoproteína transactivadora presente en la envoltura del VIH promueve la quimiotaxis neutrofílica 12 .…”

Síndrome de Sweet: relato de caso de um acontecimento raro

“…Sendo assim, o tratamento para Síndrome de Sweet é através da corticoterapia, ao qual apresenta resultados rápidos e efetivos, ajudando a confirmar o diagnóstico e ajudando ainda como critérios menores de diagnóstico em casos que precise realizar diagnóstico diferencial (Mudroch et al, 2020).…”