Case Report

Sweet Syndrome Associated with Furosemide

Authors: Gurushankar Govindarajan, MD, Qaiser Bashir, MD, Saravanan Kuppuswamy, MD, Charles Brooks, MD

Abstract

This case report describes a case of Sweet syndrome (SS) related to use of furosemide in a 46-year-old female who was admitted for treatment of congestive heart failure. Three days after administration of furosemide, the patient had a fever and a skin eruption appeared on her wrists, forearms, and legs. Biopsy of the skin lesion was consistent with SS. Infection was thought to be unlikely because of negative blood cultures, echocardiography, and other imaging studies. Careful review of her medications revealed that the patient received furosemide before the appearance of the skin eruption and fever. After discontinuation of furosemide, the patient's skin lesion and fever resolved. A MEDLINE search from June 1966 to May 2004 revealed only one reference documenting the association of SS with furosemide administration. Patients who have development of SS without an obvious cause should have their medication list closely reviewed.


Key Points


* Sweet syndrome is the prototype of acute neutrophilic dermatosis.


* The pathogenesis of Sweet syndrome remains unknown; cytokine dysregulation could account for most of the clinical, pathologic, and laboratory changes seen in Sweet syndrome.


* Sweet syndrome can be associated with infections, malignancies, autoimmune disorders, and drugs.


* The medical literature has established criteria for the diagnosis of Sweet syndrome including that secondary to drug administration.


* Careful review of a patient's medication usage is required in a patient who has development of Sweet syndrome without obvious cause.

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References

1. Sweet RD. An acute febrile neutrophilic dermatosis. Br J Dermatol 1964;74:349–356.
 
2. Reuss-Borst MA, Pawelec G, Saal JG, et al. Sweet's syndrome associated with myelodysplasia: possible role of cytokines in the pathogenesis of the disease. Br J Haematol 1993;84:356–358.
 
3. Reuss-Borst MA, Muller CA, Waller HD. The possible role of G-CSF in the pathogenesis of Sweet's syndrome. Leuk Lymphoma 1994;15:261–264.
 
4. Caughman W, Stern R, Haynes H. Neutrophilic dermatosis of myeloproliferative disorders: atypical forms of pyoderma gangrenosum and Sweet's syndrome associated with myeloproliferative disorders. J Am Acad Dermatol 1983;9:751–758.
 
5. Soppi E, Nousiainen T, Seppa A, et al. Acute febrile neutrophilic dermatosis (Sweet's syndrome) in association with myelodysplastic syndrome: a report of three cases and a review of the literature. Br J Haematol 1989;73:43–47.
 
6. Apted JH. Sweet's syndrome (acute febrile neutrophilic dermatosis) associated with multiple myeloma. Australas J Dermatol 1984;25:15–17.
 
7. Saxe N, Gordon W. Acute febrile neutrophilic dermatosis (Sweet's syndrome): four case reports. S Afr Med J 1978;53:253–256.
 
8. Gunawardena DA, Gunawardena KA, Ratnayaka RMRS, et al. The clinical spectrum of Sweet's syndrome (acute febrile neutrophilic dermatosis): a report of eighteen cases. Br J Dermatol1975;92:363–373.
 
9. Fye KH, Crowley E. Berger TG, et al. Celecoxib-induced Sweet's syndrome. J Am Acad Dermatol2001;45:300–302.
 
10. Sequeira W, Polisky RB, Alrenga DP. Neutrophilic dermatosis (Sweet's syndrome): association with a hydralazine-induced lupus syndrome. Am J Med 1986;81:558–560.
 
11. Paydas S, Sahin B, Seyrek E, et al. Sweet's syndrome associated with G-CSF. Br J Haematol1993;85:191–192.
 
12. Cobb MW. Furosemide-induced eruption simulating Sweet's syndrome. J Am Acad Dermatol1989;21:339–343.
 
13. Veres K, Haraszti A, Nemes Z, et al. Sweet syndrome following therapeutic use of granulocyte colony stimulating factor. Orvosi Hetil 1999;140:1059–1061.
 
14. Arbetter KR, Hubbard KW, Markovic SN, et al. Case of granulocyte colony-stimulating factor-induced Sweet's syndrome. Am J Hematol 1999;61:126–129.
 
15. Su WP, Liu HN. Diagnostic criteria for Sweet's syndrome. Cutis 1986;37:167–174.
 
16. Walker DC, Cohen PR. Trimethoprim-sulphamethoxazole-associated acute febrile neutrophilic dermatosis: case report and review of drug-induced Sweet's syndrome. J Am Acad Dermatol1996;34:918–923.
 
17. Nicolaides MR, Packles PJ, Schutzer PJ. Iritis associated with Sweet's syndrome. Clin Exp Dermatol 2000;25:349–354.