Sweet's syndrome associated with Mycobacterium avium infection

Area of Science:

• Dermatology
• Infectious Diseases
• Pathology

Background:

• Sweet's syndrome, also known as acute febrile neutrophilic dermatosis, is an inflammatory condition characterized by fever, neutrophilia, and tender, erythematous skin lesions.
• Nontuberculous mycobacterial (NTM) infections are caused by mycobacteria other than Mycobacterium tuberculosis, and can manifest with a variety of clinical presentations.

Observation:

• A 68-year-old woman presented with a 3-month history of erythematous nodules and plaques, accompanied by peripheral leukocytosis.
• Skin biopsy revealed diffuse dermal neutrophilic infiltration, consistent with Sweet's syndrome.
• The patient was diagnosed with Mycobacterium avium infection, identified in gastric juice via DNA-DNA hybridization.

Findings:

• Initial treatment with prednisolone improved skin lesions, but recurrence was noted upon tapering.
• Computed tomography of the lung revealed multiple lesions.
• Despite multiple antibiotic treatments, the Mycobacterium avium infection persisted, leading to subcutaneous abscess formation.

Implications:

• This case suggests a potential association between Sweet's syndrome and nontuberculous mycobacterial infection, specifically Mycobacterium avium.
• The findings underscore the importance of considering infectious etiologies in recurrent or refractory cases of Sweet's syndrome.
• Management of such cases may require a combined approach targeting both the inflammatory dermatosis and the underlying mycobacterial infection.