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Periorbital Necrotizing Sweet Syndrome: A Case Report and Literature Review
Henry Bair1, Narmien Murdock1,2, Lara Cheslow3
1Oculoplastic and Orbital Surgery, Wills Eye Hospital, Philadelphia, Pennsylvania, U.S.A.
Ophthalmic Plastic and Reconstructive Surgery
|December 31, 2025
Summary
Necrotizing periorbital Sweet syndrome mimics necrotizing fasciitis but responds to corticosteroids, not antibiotics. Early biopsy and treatment can reveal underlying myeloid leukemia and prevent harm.
Area of Science:
- Dermatology
- Hematology
- Oncology
Background:
- Necrotizing periorbital Sweet syndrome is an uncommon condition that can be mistaken for necrotizing fasciitis.
- This misdiagnosis can lead to inappropriate surgical interventions and delayed appropriate treatment.
Purpose of the Study:
- To highlight the distinct clinical presentation and management of necrotizing periorbital Sweet syndrome.
- To emphasize the association between this syndrome and underlying myeloid malignancies.
- To advocate for early biopsy and empiric corticosteroid treatment.
Main Methods:
- Case report of a 60-year-old male with periorbital necrosis.
- Review of diagnostic findings including CT, histopathology, and cultures.
- Literature synthesis on similar cases and management strategies.
Main Results:
- The patient presented with eyelid edema, pain, and necrosis unresponsive to antibiotics.
- Histopathology revealed neutrophilic dermatosis without organisms; cultures were sterile.
- Prompt improvement occurred after high-dose corticosteroids, revealing underlying acute myeloid leukemia.
Conclusions:
- Necrotizing periorbital Sweet syndrome requires a different management approach than necrotizing fasciitis.
- Consider Sweet syndrome in cases of sterile periorbital infections unresponsive to antibiotics.
- Early diagnosis and treatment with corticosteroids can avert morbidity and uncover occult malignancies like myeloid leukemia.
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