Necrotising Sweet Syndrome Associated with A Cement Burn Injury

Dr Ines Prasidha1, Professor  Peter Maitz1, Professor Peter Haertsch1

1Burns Unit Concord Hospital, Concord, Australia

Abstract

Necrotising Sweet Syndrome is a new variant of neutrophilic dermatosis, characterized by rapid onset of progressive erythematous, warm, oedematous cutaneous lesions with deep tissue neutrophilic infiltration and soft tissue necrosis, in the absence of infectious cause. To date, three cases of Necrotising Sweet Syndrome have been reported in association to immunosuppression from haematological malignancies; however, no cases have been described in relation to burn injury. We herein report the first case of Necrotising Sweet Syndrome associated with alkaline burn injury. A 35 years old man who works as a concreter, presented following cement-lime burn to his left leg with clinical findings and imaging features consistent with necrotising fasciitis. He received treatments in accordance to guideline for necrotising fasciitis, including intravenous antibiotics and surgical debridements. However, in the next ten months, he developed nine recurrent episodes associated with fever and elevated inflammatory markers; leading to multiple surgical debridement, fasciotomy, and split thickness skin grafts in addition to intravenous antibiotics.  Each time, microbiology culture results did not show any growth. He was diagnosed with Necrotising Sweet Syndrome based on clinical and histological findings. Neutrophilic dermatosis can be triggered by burn injury and is an important differential diagnosis in infective presentation post burn injury. Tissue biopsy, tissue culture, and dermatology opinion should be sought early in suspected cases.

References:

  1. Kroshinki, D, Alloo, A, Rothschild, B, Cummins, J, Tan, J, Montecino, R, Hoang, MP, Duncan, L, Mihm, M & Sepehr, A 2012, ‘Necrotizing sweet syndrome: a new variant of neutrophilic dermatosis mimicking necrotising fasciitis’, Journal of the American Academy of Dermatology, vol.67, no. 5, pp. 945-954.
  2. Villareal-Villareal, CD, Ocampo-Candiani, J & Villareal-Martinez, A 2016, ‘Sweet syndrome: a review and update’, Actas Dermosifiliogr, vol. 107, no. 5, pp. 369-378.
  3. Rosmaninho, A, Carvalho, S, & Lobo, I 2014, ‘Neutrophilic dermatoses revisited’, European Medical Journal, vol. 2, pp. 77-85.
  4. O’Halloran, E, Stewart, N, Vetrichevvel, TP, Rea, S, & Wood, F 2013, ‘Sweet’s syndrome mimicking alkali burn: a clinical conundrum, Journal of Plastic, Reconstructive & Aesthetic Surgery, vol. 66, pp. 867-869.

Biography

Dr. Ines Prasidha is an unaccredited plastic registrar. She has worked as burns registrar at Concord Hospital in 2018.

About ANZBA

ANZBA is a not for profit organisation and the peak body for health professionals responsible for the care of the burn injured in Australia and New Zealand. ANZBA encourages higher standards of care through education, performance monitoring and research.

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