The Netherlands Journal of Medicine 1999;55:235–241 Brief report A case of herpes-like Sweet’s syndrome in acute myelogenous leukemia during treatment with G-CSF a, a b * Walther N.K.A. van Mook , Martin M.F. Fickers , Joost A.M. van der Kley , c Paul H.M.H. Theunissen a Department of Internal Medicine, Atrium Medical Center, P .O. Box 4446, 6401 CX Heerlen, The Netherlands b Department of Dermatology, Atrium Medical Center, Heerlen, The Netherlands c Department of Pathology, Atrium Medical Center, Heerlen, The Netherlands Received 4 February 1999; received in revised form 11 May 1999; accepted 1 June 1999 Abstract A 49-year-old patient with refractory acute myelogenous leukemia (AML) is described who developed fever and herpes-like skin lesions during treatment with G-CSF. Skin biopsies revealed dermal neutrophilic infiltrates compatible with the diagnosis of Sweet’s syndrome. The fever and skin lesions disappeared completely after treatment with corticosteroids.  1999 Elsevier Science B.V. All rights reserved. Keywords: Acute febrile neutrophilic dermatosis; AML; G-CSF; Herpes-infection; Sweet’s syndrome Introduction patient with hematological abnormalities, often AML [4]. Several cases secondary to the use of granulo- Dermatological diseases are occasionally an ex- cyte colony-stimulating factor (G-CSF) have been pression of accompanying illnesses of internal origin. described [5,6]. We describe a patient with refractory This is also the case with acute febrile neutrophilic AML, treated with G-CSF because of granulopenia, dermatosis (AFND) or Sweet’s syndrome. The who developed high fever and herpes-like skin syndrome was first described by the British dermato- lesions, diagnosed as Sweet’s syndrome, with a good logist Sweet in 1964 [1] and termed AFND because response to corticosteroids. of acute onset of fever, leukocytosis and erythemat- ous skin lesions infiltrated by neutrophils. The presentation of the dermal abnormalities is variable, sometimes simulating herpes infection [2] or Case report erysipelas [3]. The syndrome has been linked to A 49-year-old male was diagnosed with acute myelogenous leukemia (AML), FAB-classification M5 in March 1998. The AML was secondary to a *Corresponding author. Eikenhoven 48, 6225 GT Maastricht, myelodysplastic syndrome (MDS). Complete remis- The Netherlands. Tel.: 1 31-43-363-8169; fax: 1 31-45-571- 3360. sion was obtained with induction chemotherapy, but 0300-2977 / 99 / $ – see front matter  1999 Elsevier Science B.V. All rights reserved. PII: S0300-2977(99)00080-7