Necrotizing Sweet Syndrome of the Upper Extremity After Elective Hand Surgery

• Published in: The Journal of hand surgery (American ed.) Vol. 43; no. 4; pp. 389.e1 - 389.e6
• Main Authors: Lipof, Jason S., Beck, Lisa A., Reddy, Swapna C., Southgate, Richard D., Carney-Young, Kimberly, Hammert, Warren C.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2018
• Subjects: Acellular Dermis; Adipose Tissue - pathology; Adipose Tissue - surgery; Anti-Bacterial Agents - therapeutic use; Colchicine - therapeutic use; Debridement; Dermatosis; Dupuytren Contracture - surgery; Elective Surgical Procedures; Fasciotomy; Glucocorticoids - therapeutic use; Humans; Interleukin 1 Receptor Antagonist Protein - therapeutic use; Male; Methylprednisolone - therapeutic use; Middle Aged; Necrosis - etiology; Necrosis - therapy; necrotizing; neutrophilic; pathergy; Postoperative Complications; Surgical Flaps; Sweet syndrome; Sweet Syndrome - diagnosis; Sweet Syndrome - etiology; Sweet Syndrome - therapy; Upper Extremity - pathology; Upper Extremity - surgery; Sweet syndrome; neutrophilic; Dermatosis; necrotizing; pathergy
• ISSN: 0363-5023; 1531-6564
• DOI: 10.1016/j.jhsa.2017.08.019

Sweet syndrome, or acute febrile neutrophilic dermatosis, is a systemic disease process mainly characterized by hyperpyrexia and skin lesions. A newly described entity, necrotizing Sweet syndrome, is a severe and locally aggressive dermatological condition that clinically and histopathologically resembles a necrotizing soft tissue infection. It is characterized by pathergy, a nonspecific inflammatory response to cutaneous trauma resulting in a propagation of the disease. In contrast to a necrotizing infection, this condition responds to systemic steroids. A high clinical suspicion is required in order to distinguish a necrotizing polymicrobial infection from noninfectious necrotizing Sweet syndrome. We present a case following elective hand surgery.