Decitabine-induced Sweet syndrome

Sweet syndrome, also known as acute febrile neutrophilic dermatosis, is a rare inflammatory skin condition associated with the sudden onset of high-grade fever, painful rashes usually on the upper body, leukocytosis and neutrophilia. Approximately 21% of patients with Sweet syndrome have a concurrent malignancy, 80% of which are linked to haematological diseases, especially myelodysplastic syndrome and acute myeloid leukaemia. This is a case report of a woman in her 50s who was recently diagnosed with acute myeloid leukaemia and was started on decitabine 20 mg/m² (40 mg). She complained of fever, multiple hyperpigmented nodules over her limbs with pus, swelling with erythema over the right eye and erosion over the tongue 2 days after her first round of chemotherapy. The condition was diagnosed as Sweet syndrome owing to the presence of fever, leukocytosis, elevated erythrocyte sedimentation rate and neutrophil-dense infiltrates on skin biopsy. The patient was symptomatically treated, and decitabine was dechallenged. The patient started recovering after 4 days and was discharged. On follow-up, chemotherapy with other agents were not reinitiated because of the adverse reaction which ultimately led to the patient's death.