[CASE-STUDY] Sweet Syndrome in an Elderly Man With Well-Controlled Human Immunodeficiency Virus.
This is a case of a 71-year-old male living with well-controlled human immunodeficiency virus (HIV) on antiretroviral therapy, who developed skin lesions (almost-necrotic appearing papules) on both palms of his hands, and an altered mental status.
Biopsy of skin lesions showed Sweet's syndrome (SS). The patient was initially treated with intravenous immunoglobulin, prednisone, and dapsone; and continued solely on dapsone. He responded well to treatment, but had multiple flare-ups due to not taking his medication. Dapsone and prednisone were restarted.
Due to altered mental status, neuro-Sweet's disease, a neurological variant of SS was considered. MRI scan showed enlarged spleen, and no acute vasculitis of the brain.
Two years after the patient developed SS, the skin lesions reappeared. This time, biopsy showed non-necrotizing granulomatous inflammation, leading to a diagnosis of the inflammatory condition, sarcoidosis (see comments).
Skin conditions are common in HIV (see comments). It's plausible that SS could develop secondary to HIV (plausible pathological mechanisms), but a review of the literature of persons living with HIV and diagnosed with SS has shown no clear and definite clinical association between the two conditions. However, SS should still be considered in HIV patients.
SS is possibly associated with sarcoidosis.
Mudroch, S. M., Rohan, C., Conger, N. G. and Lindhom, D. A. (2020) Sweet Syndrome in an Elderly Man With Well-Controlled Human Immunodeficiency Virus. Cureus, Sep; 12(9): e10330. cureus.com/articles/38704-s...