MDS Ain't So Sweet

Today's noon conference sparked great debate...

We discussed a patient with recent exposure to sheep and a history of MDS who developed subacute, progressive, bilateral dorsal hand papules/pustules that progressed to ulcerations and eschars on violaceous patches.

The leading diagnoses were Cutaneous Anthrax vs Neutrophilic Dermatosis of the Dorsal Hands (a variant Sweet Syndrome).  Although we came to no definite conclusion given the inconclusive biopsies and negative cultures, the journey was plentiful.

A case of Sweet's Syndrome with similar dermatologic findings.  Reference article

A case of Sweet's Syndrome with similar dermatologic findings.  Reference article

Some take-home points include:
1. When in doubt from derm, use VisualDx!
2. Sheep Exposure + Rash--> Think Tularemia, Cutaneous Anthrax, Orf (parapox virus), Brucellosis
3. 15-20% of Sweet Syndrome (Acute Febrile Neutrophilic Dermatosis) cases are associated with malignancy (most prominently hematologic malignancies).