Chemotherapy-induced Sweet's syndrome in a patient with recurrent laryngeal carcinoma

Abstract

A man in his 60s, who used to smoke at least one pack a day for more than 50 years, with a previous history of intravenous drug use, multiple tattoos and a medical history of hypertension, hypothyroidism, chronic latent hepatitis C virus (HCV) infection (no previous treatment was received), recurrent laryngeal squamous cell carcinoma (SCC) status post total laryngectomy and neck irradiation. Surgery was complicated with a pharyngocutaneous fistula repaired with a deltopectoral flap. Four months later, adjuvant chemotherapy (docetaxel/carboplatin-based regimen) was started. Three days after receiving the first cycle of adjuvant chemotherapy, he complained of an itchy rash that started on his neck and expanded to his face, chest and back that did not respond to topical emollients or topical steroids. On examination, there were 4-6 mm erythematous, exophytic papules and pustules on his face, neck, shoulders, upper chest and back (figure 1). Laboratory work-up was unremarkable including a negative HIV screen. The dermatology department was consulted, and chemotherapy-induced drug reaction versus Sweet's syndrome versus less likely disseminated skin infection was the main differential diagnosis. A skin biopsy showed diffuse neutrophilic infiltrates consistent with Sweet's syndrome (figure 2). He was started on high-dose steroids with gradual improvement of his skin lesions. He was discharged with plans to taper his steroid dose as an outpatient.