From sweet syndrome to pemphigus foliaceus: An unusual transition

A 70-year-old lady presented with acute onset of tender erythematous papules and plaques associated with fever and severe fatigue. Histopathology showed predominant neutrophilic dermal infiltration, and a diagnosis of sweet syndrome was made. The patient started on oral doxycycline and topical steroids, and the lesions started resolving. Two months later, the patient presented with altered morphology of lesions, simulating pemphigus foliaceus, and it was confirmed with a Tzanck smear, histopathology, and direct immunofluorescence. The patient started on dexamethasone-cyclophosphamide pulse therapy and has responded well. It is worth considering whether the first appearance, which resembles sweet syndrome, is a precursor of pemphigus foliaceus or an aberrant presentation of pemphigus itself. The occurrence of both conditions in the same individual in such a short period of time makes this a unique case.