Minocycline-induced Sweet’s syndrome- A case report
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A 54-year-old male presented with new-onset multiple pustular plaques affecting the dorsum of his left hand and his scalp over the 2 weeks prior to presentation. The annular lesions had a central bullous aspect, with evidence of crusting and erosive changes. The lesions were tender and had evidence of surrounding erythema. Other notable symptoms included fevers and 3 kg weight loss in that time period. His medical history was significant for diabetes mellitus and chronic airways disease, which were inactive issues.

Importantly, his general practitioner had commenced him on oral minocycline for primary frontal scalp alopecia in the week prior to the development of these lesions. His admission laboratory investigations demonstrated neutrophilia (10.1 × 109/L), elevated ESR (41 mm/h) and elevated liver function tests (ALT 114 U/L and AST 80 U/L).

Histopathology showed dermal neutrophilic infiltration with oedema and haemorrhage, diagnostic of Sweet’s syndrome (SS). His screen for malignancy with a computed tomography of the chest, abdomen and pelvis was negative. His laboratory screen for vasculitis was also negative. A diagnosis of drug-induced SS, secondary to minocycline, was established, and he was treated with an oral prednisolone 60 mg taper over 6 weeks. Minocycline was effectively ceased. His lesions improved upon follow-up with a dermatologist, with no evidence of relapse.

Acute febrile neutrophilic dermatosis, also called SS, is characterised by fever and painful erythematous papules, nodules and plaques that classically affect the limbs, face and neck. SS is rarely encountered and classified as either idiopathic SS, malignancy-associated SS, pregnancy-associated SS, inflammatory bowel disease-related SS or drug-induced SS. Some of the causes of drug-induced SS include trimethoprim–sulfamethoxazole, thalidomide, topotecan, ipilimumab, hydralazine and minocycline. The treatment for drug-induced SS predominantly involves systemic corticosteroids and cessation of the offending medication.

Source: https://academic.oup.com/omcr/article/2020/6/omaa037/5856980