Sweet’s syndrome with idiopathic epididymitis

Sweet’s syndrome (SS), also known as acute febrile neutrophilic dermatosis, is a rare condition presenting with an abrupt onset of fever and tender skin lesions with neutrophilic infiltration in the dermis, accompanied by leukocytosis [1]. Although it is not always possible to determine the etiology, SS most commonly arises as a consequence of systemic disorders. Approximately 20% of SS cases are associated with solid tumor or hematologic malignancy, most often acute myelogenous leukemia [2–5]. Cases of drug-induced SS were described after exposure to a wide variety of medication, including granulocytecolony stimulating factor [6] and other anticancer agents, antibiotics, antiepileptic, antidepressant, antihypertensive drugs, and oral contraceptives [5–8]. Pharmacotherapy-associated SS accounts for approximately 12% of SS cases [3]. The classic (idiopathic) SS type may occur in association with infections, autoimmune disorders or pregnancy [4, 9].
A 54-year-old sexually inactive man presented with acute onset of skin rash, beginning on the chest 3 days before and spreading to the face, neck, back, shoulders and arms together with intermittent fever up to 40ºC and malaise. Simultaneously, the patient complained of discomfort in the posterior part of the left testicle accompanied by redness and increased warmth of the scrotum. There was no history of dysuria or urethral discharge.
During the previous 3 years, the patient had several episodes of similar, but milder symptoms, but has never been diagnosed with SS. The patient underwent rheumatologic evaluation for Still’s disease, which was excluded. Oral glucocorticosteroid therapy with prednisone (10 mg daily) was recommended, however it did not prevent further relapses.
Physical examination at admission to the Department of Dermatology, Sexually Transmitted Diseases and Immunodermatology, revealed multiple, tender, erythematous plaques located on the face, neck, trunk and both upper extremities (Figures 1 A, B). No mucosal lesions in the oral cavity were found. Histopathological examination of the skin sample obtained from the back demonstrated dense neutrophilic infiltration with intense papillary dermal edema (Figure 2). An elevated level of white blood cell count (12.66 × 103/µl; range: 4.0–10.0 × 103/µl) with 92% neutrophils, and mild anemia (hemoglobin 10.9 g/dl; range: 12.0–18.0 g/dl) were found in the whole blood count. The C-reactive protein (CRP) and procalcitonin plasma...


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