Sweet Syndrome due to G-CSF Use in Children with Acute Lymphoblastic Leukemia; Case Report

Introduction: Sweet syndrome is characterized by fever, arthralgia, neutrophilic leukocytosis and painful erythematous plaques, which occur mostly on the face and upper extremities. It is a rare skin disease characterized by dense neutrophilic infiltration in the dermis at the lesion sites, usually seen between 30-50 years of age. Case: A nine-years-old girl with a diagnosis of acute lymphoblastic leukemia was admitted to the hospital with high fever cause. Empirical broad spectrum antibiotic and granulocyte colony stimulating factor (G-CSF) treatments were initiated for febrile neutropenia. Although antifungal therapy was added to the treatment, fever height could not be controlled. On the 14th day of G-CSF treatment, red, painful rashes were seen on the legs. The result of the skin biopsy was compatible with Sweet syndrome. G-CSF treatment was discontinued and intravenous steroids were started. The fever was controlled and the rash was lost. Conclusion: Sweet syndrome should be kept in mind when erythematous rashes develop in patients with febrile neutropenia who have been using G-CSF for a long time and who have not been able to control their fever despite appropriate antibiotics and antifungals.