J Med Cases

Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc

Journal website https://www.journalmc.org

Case Report

Volume 12, Number 12, December 2021, pages 469-473

Sweet Syndrome in an Adolescent Patient With Differentiation Syndrome Secondary to Promyelocytic Leukemia Treatment With All-Trans Retinoic Acid

Figure 1. (a) One centimeter purplish-based blister in the middle-third of left forearm. (b) Erythematous lesions in the middle and distal-third of left forearm. (c) Erythematous subcutaneous nodules in the middle-third of right leg.

Figure 2. Histopathological study. (a) Dense inflammatory infiltrate composed of neutrophils and abundant extravasation of erythrocytes in the dermis. Only mild spongiosis (arrow) is observed in the epidermis (hematoxylin and eosin, × 10). (b) Dense neutrophilic inflammatory infiltrate, abundant cellular debris and formation of papillary micro abscesses (arrow) (hematoxylin and eosin, × 10). (c) Neutrophilic inflammatory infiltrate (circle), cells with multilobulated nuclei and less eosinophilic cytoplasm (arrow), abundant cellular debris, and scattered extravasated erythrocytes (hematoxylin and eosin, × 10).

**Table 1.** Factors Associated With Sweet Syndrome Modified From Reference [4]
BCG: bacille Calmette-Guerin.
Paraneoplastic	Acute lymphoid leukemia
	Acute myeloid leukemia
	Juvenile myelomonocytic leukemia
	Myelodysplastic syndromes
	Osteosarcoma
	Fanconi anemia
	Aplastic anemia
Inflammatory diseases	Systemic lupus erythematosus
	Auto immune hepatitis
	Crohn’s disease
Infections	Human immunodeficiency virus
	Rotavirus
	Otitis media
	Tonsilitis
	Acute respiratory infections
Drug treatment	Colony stimulating factors
	Trimethoprim sulfamethoxazol
	Retinoids
	Azathioprine
	Contraceptives
	Minocycline
	Carbamazepine
	Tyrosine kinase inhibitors
Vaccines	BCG
	Measles
	Influenza
	Pneumococcus
Pregnancy	-

Table 1. Factors Associated With Sweet Syndrome Modified From Reference [4]

BCG: bacille Calmette-Guerin.

Paraneoplastic

Acute lymphoid leukemia

Acute myeloid leukemia

Juvenile myelomonocytic leukemia

Myelodysplastic syndromes

Osteosarcoma

Fanconi anemia

Aplastic anemia

Inflammatory diseases

Systemic lupus erythematosus

Auto immune hepatitis

Crohn’s disease

Infections

Human immunodeficiency virus

Rotavirus

Otitis media

Tonsilitis

Acute respiratory infections

Drug treatment

Colony stimulating factors

Trimethoprim sulfamethoxazol

Retinoids

Azathioprine

Contraceptives

Minocycline

Carbamazepine

Tyrosine kinase inhibitors

Vaccines

BCG

Measles

Influenza

Pneumococcus

Pregnancy

**Table 2.** Diagnostic Criteria Proposed by Su and Liu in 1986 and Modified by Von Den Driesch in 1992 [12]
ESR: erythrocyte sedimentation rate; PBS: peripheral blood smear; PMN: polymorphonuclear.
Major criteria	Sudden appearance of painful or erythematous plaques, nodules, pustules, or blisters
	Neutrophilic infiltration of the dermis without leukocytoclastic vasculitis
Minor criteria	Clinical picture preceded by the application of vaccines or a respiratory or gastrointestinal infection, associated or not with: 1) inflammatory diseases such as autoimmune disorders; 2) lymphoproliferative diseases or solid tumors; and 3) pregnancy.
	Clinical picture preceded by fever and general discomfort
	Laboratories results altered at the beginning of the clinical picture: ESR > 20 mm/h, positive C-reactive protein, PBS > 70% PMN, leukocytes > 8,000 cells/µL
	Excellent response to treatment with systemic steroids or potassium iodide

Table 2. Diagnostic Criteria Proposed by Su and Liu in 1986 and Modified by Von Den Driesch in 1992 [12]

ESR: erythrocyte sedimentation rate; PBS: peripheral blood smear; PMN: polymorphonuclear.

Major criteria

Sudden appearance of painful or erythematous plaques, nodules, pustules, or blisters

Neutrophilic infiltration of the dermis without leukocytoclastic vasculitis

Minor criteria

Clinical picture preceded by the application of vaccines or a respiratory or gastrointestinal infection, associated or not with: 1) inflammatory diseases such as autoimmune disorders; 2) lymphoproliferative diseases or solid tumors; and 3) pregnancy.

Clinical picture preceded by fever and general discomfort

Laboratories results altered at the beginning of the clinical picture: ESR > 20 mm/h, positive C-reactive protein, PBS > 70% PMN, leukocytes > 8,000 cells/µL

Excellent response to treatment with systemic steroids or potassium iodide