Sweet syndrome associated with furosemide

Area of Science:

• Dermatology
• Cardiology
• Pharmacology

Background:

• Sweet syndrome (SS) is an uncommon neutrophilic dermatosis characterized by fever, skin lesions, and dense neutrophilic infiltration of the dermis.
• Drug-induced SS is a recognized entity, but associations with specific medications are continually being identified.
• Congestive heart failure (CHF) management often involves diuretics like furosemide, which can have various side effects.

Observation:

• A 46-year-old female with CHF developed fever and a characteristic skin eruption (papules and plaques) on her extremities three days after starting furosemide.
• Skin biopsy confirmed Sweet syndrome, and infectious causes were ruled out through extensive investigations.
• The patient's symptoms resolved rapidly after furosemide was discontinued, with no recurrence.

Findings:

• This case report details a potential association between furosemide and the development of Sweet syndrome.
• A review of literature identified only one prior report linking furosemide to SS.
• The temporal relationship between furosemide administration and symptom onset, followed by resolution upon withdrawal, strongly suggests a causal link.

Implications:

• Clinicians should consider Sweet syndrome in patients presenting with fever and rash, especially those on furosemide.
• Reviewing medication history is crucial for diagnosing drug-induced SS when no other cause is apparent.
• This finding expands the known spectrum of drug-induced hypersensitivity reactions and highlights the importance of pharmacovigilance.