Necrotising sweet syndrome mimicking necrotising fasciitis: a diagnostic challenge

Sweet syndrome is a neutrophilic dermatosis characterised by fever and multifocal tender, erythematous plaques or papules, which may enlarge or coalesce to form plaques with an uneven mamillated surface. Necrotizing sweet syndrome (NSS) is a severe and locally aggressive variant that may resemble necrotizing soft tissue infection clinically. In contrast to necrotizing fasciitis where prompt surgical debridement and broad-spectrum antibiotics are the mainstay of treatment, necrotizing sweet syndrome responds to systemic corticosteroids and immuno-suppressants. Surgical interventions may in fact result in propagation of the disease due to the pathergy phenomenon.
Herein we report a case of necrotizing sweet syndrome involving lower limbs mimicking necrotizing fasciitis where initial surgical interventions resulted in a threatened limb and therapeutic challenges. The patient responded to high dose systemic corticosteroids and immunosuppressants. This case highlights the importance of communication between the surgeon, dermatologist and pathologist for early diagnosis of necrotizing sweet syndrome to reduce morbidity.