Sweet's syndrome in a patient with Wegener's granulomatosis and ESRD

A female patient in her late 60s with end stage renal disease secondary to Wegener's granulomatosis presented with a 2-day history of fever, nausea, somnolence and purple coloured exudative plaques on her forehead and index finger. Herpes zoster was the initial diagnosis and acyclovir was prescribed. Twenty-four hours later, her level of consciousness (LOC) had declined to a Glascow coma scale of 10/15 and she started exhibiting myoclonic jerks. The lesions progressed to both sides of the face and acyclovir was discontinued as it was felt to be contributing to the myoclonic jerks. CT scan of the brain and lumbar puncture revealed no abnormalities to explain diminished LOC. Septic screen was negative, and an EEG showed no ictal activity. Skin biopsy revealed neutrophilic dermal infiltrates, leading to the diagnosis of Sweet's syndrome and prednisone (1 mg/kg) was initiated. The patient's condition improved over 12 h and she was discharged 5 days later. She died 6 weeks later from her cardiac disease.