What are the symptoms of Sweet’s syndrome? Does it only affect the skin?

[Shell567]

The main symptom of Sweet's syndrome (acute febrile neutrophilic dermatosis) is skin lesions that often appear as a sore or painful red/purple rash. Patients can also develop other symptoms. These symptoms include:

1. Unexplained fever - normally 38 degrees centigrade or above. Occurs in most patients.

2. Fatigue (often tiredness or exhaustion that you can't 'shake-off').

3. Headache, or less commonly, migraine. More commonly associated with the Sweet's syndrome variant, neuro-Sweet's disease.

4. Joint pain.

5. Joint swelling (arthritis).

6. Muscle pain.

7. Sore eyes and other eye problems. Rarely, sight-threatening.

8. Mouth ulcers. More commonly associated with Behcet's syndrome. This is a similar condition to Sweet's syndrome - a neutrophilic dermatosis.

Rarely, Sweet’s syndrome can affect internal organs such as the brain (neuro-Sweet's), heart, lungs and spleen.

[MMMM55]

Thought I had conjunctivitis for the second time, but it did not clear up with the usual drops for 10 days. Now my eye is still blood shot, glassy, and I have blurred vision, trouble focusing. Going to the optomolgist today to see what's going on now!

[Shell567 Administrator Sweet's Syndrome UK]

Hi MMMM55, good luck with your appointment.

[MMMM55]

Thanks, they seem better. I still have blurred vision especially in the left eye. Dr. gave me steroid drops to use before for a short period, but I don't know if I should use them on an ongoing thing?

[Shell567 Administrator Sweet's Syndrome UK in reply to MMMM55]

Hi MMMM55, in the long-term it's not a good idea to use steroid eye drops on a regular basis. If your conjunctivitis keeps flaring up, it possibly means that you need oral medication to properly treat your SS.

Side-effects of steroid eye-drops, particularly over the longer term: increased pressure inside the eye; cataracts; blurred vision; higher risk of developing eye infections.

[MMMM55 in reply to Shell567]

Thanks, Shell567, the pink eye isn't back...just blurry and not right? I am on 150 mg. of Dapsone now, but my liver enzymes are elevated, so we may have to make changes. There is so much confusion with this disease, I am so achy and have no energy, don't know if it is Sweets or I am just old and lazy!

[Shell567 Administrator Sweet's Syndrome UK in reply to MMMM55]

Hi MMMM55, unfortunately some people can struggle with the side-effects of dapsone.

Feeling achy and exhaustion are common symptoms of SS. It's not you being lazy!

I hope you find a treatment that works for you soon. x

[eyelady30 in reply to Shell567]

I am a "sweetie" from the USA. I have had SS for about 16 months when rash started, diagnosed 6 mos.one 3rd round of prednisone. Now seeing an allergist for skin test and want to try infra red sauna to remove body toxins. Nothing to lose. will post updates.

[e-mail]

[Shell567 Administrator Sweet's Syndrome UK]

Neutrophilic Dermatoses (includes Sweet's and Behcet's), DermNet NZ: dermnetnz.org/topics/neutro...

[Shell567 Administrator Sweet's Syndrome UK]

Case Report: Sweet Syndrome as an Initial Presentation of Crohn’s Disease, JULY 2022. the-rheumatologist.org/arti...

Sweet’s syndrome developing secondary to Crohn’s disease.

“Here, we discuss a case of Sweet syndrome as the initial presentation of Crohn’s disease, manifesting with bullous skin lesions, splenic cysts, acute arthritis and an intraosseous calcaneal lesion.”

Crohn’s disease – inflammatory bowel disease (IBD).

Bullous skin lesions – large blister-type lesions.

Splenomegaly and large splenic cysts – enlarged spleen and large fluid-filled structures in the spleen. No infectious cause found.

Pleural effusion – the build-up of excess fluid between the layers of the pleura outside the lungs. No infectious cause found.

Intraosseous calcaneal lesion – lesion in heel bone.

Polyarticular arthritis – arthritis affecting many joints.

Extracutaneous – areas/affecting areas other than the skin.

Extraintestinal – areas/affecting areas other than the intestine.

“An 18-year-old woman was transferred to our institution for evaluation of persistent fevers and polyarticular arthritis that began 10 days prior to transfer. Symptoms began with pain in her bilateral ankles and associated blisters on the lateral malleoli. She then developed swelling in her feet, with fixed internal rotation.”

“A computed tomography (CT) scan of her chest, abdomen and pelvis revealed a left, lower lobe consolidation in her lung with a large left pleural effusion, and splenomegaly with numerous large cystic lesions.”

“The patient was discharged home with a prolonged prednisone taper and plans to follow up with the gastroenterology and rheuma­tology services as an outpatient. Over the next two months, the patient began treatment with adalimumab for Crohn’s disease and completed her prednisone taper.”

“Classic Sweet syndrome has been reported as a rare extracutaneous manifestation in patients with IBD. Most of these cases have been reported in women and are associated with colonic disease. Further, it has been associated with active disease in up to 80% of patients.

Patients who develop Sweet syndrome-associated IBD have more frequent extraintestinal manifestations of IBD, with one case report citing 77% of patients developing an extraintestinal mani­festation. Sweet syndrome can present at any time in patients with IBD, with 21% of patients developing Sweet syndrome prior to a diagnosis of IBD.”

“…any organ system can be involved in Sweet syndrome.”

“Arthritis, along with other musculo­skeletal manifestations, have been reported in up to 59% of cases of Sweet syndrome. The arthritis is migratory, asymmetric, non‑deforming and involves at least two joints. The knees and wrists are reportedly the most frequently affected, followed by ankles, elbows and fingers.”