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Robert Sweet first described acute febrile neutrophilic dermatosis (Sweet's syndrome (SS)) in 1964 affecting eight women. They had four cardinal features: fever, neutrophilia, tender plaques and dermal infiltrate of neutrophils histologically.1 SS is rare and occurs worldwide with no racial predilection.2 Associations include infections, drugs, malignancy, inflammatory bowel disease and pregnancy.2 We present a case of SS in a patient with biliary sepsis.
A 54-year-old Caucasian man developed pyrexia, leukocytosis with neutrophilia and raised C-reactive protein one day after transhepatic biliary stent insertion. Intravenous piperacillin/tazobactam (Tazocin, Pfizer, USA) was started for presumed biliary sepsis. He remained pyrexial 2 days later. The antibiotic was changed to meropenem. He remained unwell with swinging pyrexia while his leucocytosis, neutrophilia and C-reactive protein worsened over the following 5 days. Two days after he became unwell, …