Sweet syndrome criteria

Q: 42 years old female is admitted to ICU with a high fever and abrupt onset of painful erythematous nodules mostly in upper extremities after COVID-19 vaccine. Diagnosis of sweet syndrome is made. Excellent response to steroids is considered a major criteria for the diagnosis of Sweet syndrome?

A) True

B) False

Answer: B

A revised set of diagnostic criteria based upon original 1986 criteria is the most widely used. Both major and two of four minor criteria are required to establish a diagnosis of classical or malignancy-associated Sweet syndrome:

Major criteria:

• Abrupt onset of painful erythematous plaques or nodules
• Histopathologic evidence of a dense neutrophilic infiltrate without evidence of leukocytoclastic vasculitis

Minor criteria:

• Pyrexia >38°C
• Association with underlying hematologic or visceral malignancy, inflammatory disease or pregnancy, or preceded by upper respiratory infection, gastrointestinal infection, or vaccination
• Excellent response to treatment with systemic glucocorticoids or potassium iodide
• Abnormal laboratory values at presentation (three of four of the following: erythrocyte sedimentation rate >20 mm/hour, positive C-reactive protein, >8000 leukocytes, >70 percent neutrophils)

Case reports of sweet syndrome have been reported after COVID-19 vaccine.

#dermatology

#malignancy

References:

1. von den Driesch P. Sweet's syndrome (acute febrile neutrophilic dermatosis). J Am Acad Dermatol 1994; 31:535. 

2. Agharbi FZ, Oqbani K, Allaoui A, Chikhaoui I, Chiheb S. Sweet syndrome in post-COVID-19 infection: A case report. Travel Med Infect Dis. 2021 Nov-Dec;44:102188. doi: 10.1016/j.tmaid.2021.102188. Epub 2021 Oct 22. PMID: 34688892; PMCID: PMC8530785.