Case of granulocyte colony‐stimulating factor–induced Sweet's syndrome

A 33‐year‐old male was referred with a two‐week history of fevers to 40°C and painful, erythematous skin and oral mucosal eruptions that had failed to respond to multiple anti‐infectious agents. He had a recent diagnosis of a “myeloproliferative disorder with myelodysplastic features” on bone marrow biopsy, with associated pancytopenia. Two weeks before admission, he had been treated with a course of granulocyte colony‐stimulating factor (G‐CSF) at a dose of 300 μg/day in an attempt to improve his neutropenia. After four days of treatment, the fever and lesions developed. Infectious evaluation was negative; however, biopsies of the skin and oral mucosal lesions revealed histology consistent with Sweet's syndrome. Intravenous methylprednisolone (30 mg/day) was started with prompt defervescence and resolution of the lesions within days. With the increasing use of G‐CSF, Sweet's syndrome is becoming more commonly recognized as an adverse effect. This is the first case of G‐CSF–induced Sweet's syndrome to demonstrate gingival involvement. Am. J. Hematol. 61:126–129, 1999. © 1999 Wiley‐Liss, Inc.