Postpartum Sweet’s Syndrome: A Rare but Serious Neutrophilic Dermatosis with Systemic Manifestations
A 30-year-old woman developed fever, abdominal pain, and skin ulcers 6 days after delivering her first child at 35 weeks gestation. Initially treated for suspected endometritis, her condition worsened despite broad-spectrum antibiotics. The case highlights the challenges in diagnosing Sweet’s syndrome, a rare neutrophilic dermatosis that can mimic infection and have severe systemic manifestations.
Key Points:
- The patient presented with fever, abdominal pain, and leukocytosis 6 days postpartum.
- Initial diagnosis was endometritis, but symptoms persisted despite antibiotic therapy.
- Imaging revealed intra-abdominal fluid collections, ascites, and anasarca.
- Skin lesions developed, including ulcerating plaques at sites of minor trauma (pathergy).
- Skin biopsy showed dense neutrophilic infiltrate without vasculitis, consistent with Sweet’s syndrome.
- Diagnosis of Sweet’s syndrome was based on major and minor criteria, including typical skin lesions, histopathology, fever, and elevated inflammatory markers.
- Pregnancy-associated Sweet’s syndrome is rare, accounting for only 2% of cases.
- Systemic manifestations included possible pulmonary involvement and right heart strain.
- Treatment with high-dose glucocorticoids led to rapid improvement within 12 hours.
- Sweet’s syndrome can recur in subsequent pregnancies but overall has favorable perinatal outcomes.
- Differential diagnosis included endometritis, pyogenic infections, and other neutrophilic dermatoses.
- The patient’s history of hidradenitis suppurativa and family history of inflammatory conditions may have been relevant risk factors.
- Timely diagnosis and treatment are crucial to prevent progression to severe organ involvement.
- Sweet’s syndrome can be associated with malignancy, infections, drugs, or inflammatory conditions.
- First-line treatments include systemic glucocorticoids, dapsone, potassium iodide, and colchicine.
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Classical Sweet syndrome in adults affects women more often than men by as much as 15:1 by some estimates. This female preponderance has not been seen in malignancy-associated or drug-induced Sweet syndrome. Classical Sweet syndrome usually affects women between the ages of 30-50, but can be seen in individuals of any age including children. (NORD)
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