Treatment: Corticosteroids, not antibiotics
A high clinical suspicion for Sweet’s syndrome is critical to management decisions because the primary treatment is corticosteroids, rather than antibiotics.5,6 Oral prednisone at 0.5 to 1.5 mg/kg per day with taper over 2 to 6 weeks is a standard regimen.2 IV methylprednisolone of up to 1000 mg per day for 3 to 5 days, followed by a tapered oral dose of corticosteroids over several weeks is another option.5 Other first-line treatment options include colchicine (0.5 mg 3 times a day) and oral potassium iodide (300 mg enteric-coated tablets 3 times a day).5,6 Indomethacin, cyclosporine, surgery, and dapsone are other options/adjuncts.
Recurrences of Sweet’s syndrome may occur, regardless of treatment. They are more likely to occur in patients with an underlying malignancy and may herald recurrence of malignancy in a previously treated patient.5 Treating an underlying malignancy (or discontinuing the causative medication in drug-induced Sweet’s syndrome) may resolve symptoms. IV administration of methylprednisolone, as discussed earlier, has been successful for refractory cases.5
Our patient responded well to treatment
Our patient was started on prednisone 60 mg daily and her antibiotics were discontinued. Within 24 hours, her skin lesions regressed. She was discharged on a tapering course of the prednisone.
After several weeks, her lesions completely cleared without scarring or recurrence.
CORRESPONDENCE
Ryan A. Withrow, DO, 4-2807 Reilly Road, Family Medicine Residency Clinic, Fort Bragg, NC 28314; ryan.withrow@us.army.mil