Acute febrile neutrophilic dermatosis and abnormal bone marrow chromosomes as a marker for preleukemia

Acute febrile neutrophilic dermatosis or Sweet's syndrome is a rare disease, which occasionally is seen in patients with myeloid leukemia. We present a case of Sweet's syndrome in a patient with an abnormal chromosome pattern in bone marrow aspirate. Initially the patient had flu-like symptoms with high fever. Two weeks later raised, erythematous and painful plaques appeared on the skin. Various antibiotics were ineffective, but the symptoms vanished after administration of prednisone. Six months later a fulminant acute myeloid leukemia developed, the course of which was complicated by a fatal subdural bleeding. It is concluded that Sweet's syndrome may be a cutaneous sign of a neoplastic myeloid proliferation and that a complete hematological examination including chromosome analysis is mandatory in these patients.