Images in Clinical Medicine

Acute Febrile Neutrophilic Dermatosis in Acute Myelogenous Leukemia

Michel Starobinski, M.D., and Denis Salomon, M.D.

N Engl J Med 1998; 339:1687December 3, 1998

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Figure 1 Several erythematous nodules and papulopustules developed on the arms (Panel A), upper legs, and face of a 57-year-old man, accompanied by a fever (temperature as high as 40°C) despite treatment with broad-spectrum antibiotics and amphotericin B, during chemotherapy with cytarabine and idarubicin for acute myelogenous leukemia type M4 according to the French–American–British system of classification. On day 7 of induction therapy, the patient's white-cell count was 500 per cubic millimeter and a biopsy showed a dense infiltrate of neutrophils (arrowheads in Panel B) and mononuclear cells around the sweat glands that extended into the adipose tissue (the letter “F” in Panel B denotes a fat lobule). A diagnosis of acute febrile neutrophilic dermatosis (Sweet's syndrome) was made. Intravenous therapy with corticosteroids resulted in the rapid disappearance of the lesions and defervescence. Acute febrile neutrophilic dermatosis can precede or accompany malignant diseases, most commonly hematopoietic tumors.

Michel Starobinski, M.D.
Denis Salomon, M.D.
Geneva University Hospital, 1211 Geneva 14, Switzerland

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