Unusual presentation of Sweet's syndrome involving palms and its dermoscopy

• Published in: BMJ case reports 2022-05, Vol.15 (5), p.e249352
• Main Authors: Yumnam, Deepak, Melanda, Hijam, Batra, Anmol, Bhatia, Riti
• Format: Article
• Language: English
• Subjects: Antibiotics; Blood vessels; Case reports; Dermatology; Dermoscopy; Edema; Hands; Hematology; Humans; Images In; Leukemia; Microscopy; Skin diseases; Sweet Syndrome - diagnosis; Sweet Syndrome - drug therapy
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2022-249352

All other investigations (renal function test, liver function test, urine routine examination with microscopy, blood culture and sensitivity, urine culture and sensitivity, HBsAg, HCV Ab, chest X-ray and ECG) were within normal limits apart from elevated erythrocyte sedimentation rate (40 mm/hour). The pronounced oedema in the upper dermis gives the lesion an illusion of vesiculation.2 In malignancy-associated SS, lesions may appear bullous, ulcerated and may resemble pyoderma gangrenosum.3 The predominant involvement of both palms in our patient is a rare presentation, as the common sites include the head, neck, upper extremities and sometimes the dorsal aspects of hands.4 5 Malignancy-associated SS (20%) is most often associated with haematological disorders, among which acute myelogenous leukaemia is the most common. Other agents include dapsone, potassium iodide, colchicine, indomethacin, clofazimine, cyclosporine and antibiotics.3 To the best of our knowledge, only three cases of SS with palmoplantar involvement have been reported and dermoscopy of SS has been reported only once.6–9 We report additional findings of red clods and dotted vessels over a pinkish background, corresponding with histological findings of dilated capillaries and extravasated red blood cells.