Giant cellulitis-like Sweet syndrome with myofasciitis: Multimodality imaging findings and streptococcal trigger, 2025. sciencedirect.com/science/a...
CASE-STUDY.
"This case represents an unusual presentation of biopsy-proven giant cellulitis-like Sweet syndrome associated with both neutrophilic myofasciitis and systemic inflammatory response syndrome, likely triggered by preceding group A streptococcal infection."
- 34-year-old woman with fever, raised white blood cell count, and a painful reddened right thigh skin lesion (plaque). Initially started on antibiotics for presumed cellulitis, but symptoms worsened (low blood pressure and presumed septic shock, the severest stage of sepsis).
- MRI scan of right thigh showed myofasciitis with probable neutrophilic infiltration. Myofasciitis is a condition that involves inflammation of the muscles and fascia (layer of connective tissue that lies beneath the skin and between the muscles and organs in the body).
- Right thigh fasciotomy (surgical procedure where the fascia is cut) was performed to further investigate, but no signs of infection.
- CT and ultrasound scan of the right thigh revealed early myonecrosis (death of muscle connected to the bone due to lack of blood supply) caused by inflammation.
- Skin biopsy showed Sweet's syndrome, and a diagnosis of giant cellultis-like Sweet's syndrome with muscle involvement was given. Also, systemic inflammatory response syndrome (not related to infection), intially thought to be septic shock.
- Sweet's syndrome had probably been triggered by streptococcal infection. Rising anti-strep (antistreptolysin O) antibody levels suggested recent infection, even though no other tests indicated infectious disease.
- Treatment was high dose intravenous steroids.
ADDITIONAL INFO.
SYSTEMIC INFLAMMATORY RESPONSE SYNDROME (SIRS).
There are a small number of Sweet's syndrome cases associated with SIRS. It can cause many symptoms, including fever and low blood pressure.
WHAT IS SIRS?
SIRS is an exaggerated defense response to a harmful stressor, resulting in severe inflammation throughout the body. Stressors include:
Infection (sepsis is when SIRS is associated with infection).
Surgery.
Sudden and severe inflammation (includes Sweet's syndrome)
Lack of blood flow to an area of your body.
Cancer.
CELLULITIS AND CELLULITIS-LIKE SWEET'S SYNDROME.
Cellulitis is a bacterial infection of the skin which can trigger Sweet’s syndrome or look like it.
Sweet’s syndrome that looks like cellulitis is called cellulitis-like Sweet’s syndrome. It usually affects one part of the body, and is sometimes associated with cancer.
GIANT CELLULITIS-LIKE SWEET'S SYNDROME.
Giant cellulitis-like Sweet’s syndrome is a rare variant of Sweet’s syndrome that affects a larger part of the body than cellulitis-like Sweet’s syndrome. It most commonly causes giant raised-red skin lesions that have a swollen appearance, but other lesion types may be seen
