Sweet’s syndrome: disease spectrum from an Indian perspective


  • Sukhjot Kaur Department of Dermatology and Venereology, Dayanand Medical College and Hospital, Ludhiana, Punjab
  • Amit Kumar Dhiman Division of Medical Oncology, Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab
  • Sandeep Kaur Department of Dermatology and Venereology, Dayanand Medical College and Hospital, Ludhiana, Punjab
  • Vikram Narang Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab
  • Sunil Kumar Gupta Department of Dermatology and Venereology, Dayanand Medical College and Hospital, Ludhiana, Punjab
  • Neena Sood Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab




Sweet’s syndrome, Malignancy, Histiocytoid Sweet’s


Background: Sweet's syndrome is characterized by sudden onset of tender, erythematous papules, nodules, and plaques with a characteristic histopathology. It arises in three clinical settings- idiopathic, drug induced and malignancy induced. It has several clinical and histopathologic variants. Newer entities have been recently described in literature, thereby, emphasizing the need for continuous research. So, this study was conducted to add to scant data published in Indian literature with respect to this uncommon disease. The aims of the study were to bring insights into this rarely seen condition with special emphasis on histopathology; to highlight association of Sweet's syndrome with other systemic diseases, and its extra-cutaneous manifestations.

Methods: A retrospective analysis of medical records from January 2013 to February 2017 of patients with Sweet’s syndrome was done in our dermatology department in a tertiary care hospital.

Results: Out of total 13 patients, 6 (46%) were males and 7 (54%) were females. The age of patients ranged from 33 to 82 years. Five (39%) had idiopathic Sweet's syndrome, while 8 (61%) had non-idiopathic Sweet's syndrome, out of which three were associated with autoimmune diseases (ulcerative colitis, interstitial lung disease and crohn’s disease in 1 patient each), 3 cases were associated with malignancy (chronic neutrophilic leukemia, chronic myeloid leukemia and acute myelogenous leukemia in 1 patient each) and 2 cases were linked with infection. Bullous Sweet's syndrome was seen in 2 (15%) while neutrophilic dermatosis of dorsal hands was diagnosed in 5 (39%) cases. Four patients developed uncommon extracutaneous manifestations of Sweet's syndrome. In addition to classical histopathological findings of Sweet's syndrome, one case showed presence of immature neutrophils (histiocytoid Sweet's syndrome), fibrinoid necrosis was evident in 2 (15.4%), leucocytoclasia in 6 (46.2%), RBC extravasation in 3 (23.1%) and neutrophilic infiltration into vessel wall in 3 (23.1%) patients.

Conclusions: Several unique variants were observed in the current study.


Sweet RD. An acute febrile neutrophilic dermatosis. Br J Dermatol. 1964;76:349-56.

Cohen PR. Sweet’s syndrome – a comprehensive review of an acute febrile neutrophilic dermatosis. Orphanet J Rare Dis. 2007;2:34.

Paydas S. Sweet’s syndrome: a revisit for hematologists and oncologists. Crit Rev Oncol Hematol. 2013;86:85-95.

Anzalone CL, Cohen PR. Acute febrile neutrophilic dermatosis (Sweet’s syndrome). Curr Opin Hematol. 2013;20:26-35.

Malone JC, Slone SP. Sweet Syndrome: a disease in histologic evolution? Arch Dermatol. 2005;141:893-5.

Callen JP. Neutrophilic dermatoses. Dermatol Clin. 2002;20:409-19.

Neoh CY, Tan AW, Ng SK. Sweet’s syndrome: a spectrum of unusual clinical presentations and associations. Br J Dermatol. 2007;156:480-5.

Corazza M, Lauriola MM, Borghi A, Marzola A, Virgili A. Sweet’s syndrome: a retrospective clinical, histopathological and immuno-histochemical analysis of 11 cases. Acta Derm Venereol. 2008;88:601-6.

Abbas O, Kibbi AG, Rubeiz N. Sweet’s syndrome: a retrospective study of clinical and histologic features of 44 cases from a tertiary care centre. Int J Dermatol. 2010;49:1244-9.

Hospach T, von den Driesch P, Dannecker GE. Acute febrile neutrophilic dermatosis (Sweet’s syndrome) in childhood and adolescence: two new patients and review of the literature on associated diseases. Eur J Pediatr. 2009;168:1-9.

Cohen PR, Kurzrock R. Sweet’s syndrome and Cancer. Clin Dermatol. 1993;11:149-57.

Kaur S, Bery A, Garg B, Sood N. Sweet's syndrome associated with chronic neutrophilic leukemia. Indian J Dermatol Venereol Leprol. 2015;81:203-6.

Kaur S, Gupta D, Garg B, Sood N. Neutrophilic dermatosis of dorsal hands. Indian Dermatol Online J. 2015;6:42-5.

Woodrow SL, Munn SE, Basarab T, Russel Jones R. Sweet’s syndrome in association with non-Hodgkin’s lymphoma. Clin Exp Dermatol. 1996;21:357-9.

Gille J, Spieth K, Kaufmann R. Sweet’s Syndrome as initial presentation of diffuse large B-cell lymphoma. J Am Acad Dermatol. 2002;46:11-3.

Ayirookuzhi SJ, Ma L, Ramshesh P, Mills G. Imatinib-induced Sweet syndrome in a patient with chronic myeloid leukemia. Arch Dermatol. 2005;141:368-70.

Brazzelli V, Grasso V, Borroni G. Imatinib, dasatinib and nilotinib:a review of adverse cutaneous reactions with emphasis on our clinical experience. J Eur Acad Dermatol Venereol. 2013;27:1471-80.

Peroni A, Colato C, Schena D, Rongioletti F, Girolomoni G. Histiocytoid Sweet syndrome is infiltrated predominantly by M2-like macrophage. J Am Acad Dermatol. 2015;72:131-9.

Requena L, Kutzner H, Palmedo G, Pascual M, Fernandez-Herrera J, Fraqa J, et al. Histiocytoid Sweet syndrome:a dermal infiltration of immature neutrophilic granulocytes. Arch Dermatol. 2005;141:834-42.

Bush JW, Wick MR. Cutaneous histiocytoid Sweet syndrome and its relationship to hematological diseases. J Cutan Pathol. 2016;43:394-9.

Cohen PR. Skin lesions of Sweet syndrome and its dorsal hand variant contain vasculitis:an oxymoron or an epiphenomenon? Arch Dermatol. 2002;138:400-3.

Sutra-Loubet C, Carlotti A, Guillemette J, Wallach D. Neutrophilic panniculitis. J Am Acad Dermatol. 2004;50:280-5.

Cohen PR. Subcutaneous Sweet’s Syndrome:a variant of acute febrile neutrophilic dermatosis that is included in the histopathologic differential diagnosis of neutrophilic panniculitis. J Am Acad Dermatol. 2005;52:927-8.

Cohen PR, Kurzrock R. Treatment of Sweet’s syndrome. Am J Med. 1990;89:396.






Original Research Articles