A RARE PRESENTATION OF FEVER WITH SKIN LESIONS - CLASSICAL SWEET'S SYNDROME

Sweet's Syndrome also known as Gomm button disease or Acute Febrile Neutrophilic dermatosis, is an uncommon disease with an incidence of less than 1 in 10,00,000(1). It is a disease characterized by sudden onset of fever, elevated white blood cell count, tender, erythematous skin lesions and arthritis. The syndrome may be idiopathic or due to infections, secondary to malignancy, drugs and rheumatic diseases. Here we report , a 9 years old boy born to non - consanguineous parents who presented with fever, vomiting, arthritis, cough and cold . He had tender erythematous papulo nodular skin lesions over the dorsum of the right hand . On evaluating the patient had leucocytosis , raised ESR and positive CRP . During the hospital stay child developed new crops of targetoid lesions all over the body. Having erythema multiforme, polyarteritis nodosa and Sweet's syndrome as differential diagnosis, skin biopsy was done which revealed dense neutrophilic infiltrates in dermis. Based on the diagnostic criteria(3,4) with clinical and skin biopsy findings the diagnosis of a rare entity called Sweet's Syndrome was made. Child was started on oral prednisolone 2mg per kg , child became afebrile and started improving with clearing of skin lesions without scarring. This case is being presented for its rarity and to emphasise the fact, early diagnosis and treatment will cure the disease completely.