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Acute febrile neutrophilic dermatosis (Sweet's syndrome) in a patient with biliary sepsis
  1. Adrian S W Yong1,
  2. Kevin Y C Lee1,
  3. Joseph Murphy2,
  4. Martin Phillips3,
  5. Simon Rushbrook3,
  6. Jennifer J Garioch1
  1. 1Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, UK
  2. 2Department of Cellular Pathology, Norfolk and Norwich University Hospital, Norwich, UK
  3. 3Department of Gastroenterology, Norfolk and Norwich University Hospital, Norwich, UK
  1. Correspondence to Dr Adrian Yong, Department of Dermatology, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK; adrian.yong{at}nnuh.nhs.uk

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Introduction

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.

Case history

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 …

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