Makis et al. Journal of Medical Case Reports 2010, 4:281 http://www.jmedicalcasereports.com/content/4/1/281 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Acute febrile neutrophilic dermatosis (Sweet’s syndrome) in a child, associated with a rotavirus infection: a case report Alexandros Makis1*, Stavros Stavrou1, Nikolaos Chaliasos1, Aikaterini Zioga2, Antonios P Vlahos1, Georgios Gaitanis3, Antigone Siamopoulou1, Ioannis D Bassukas3 Abstract Introduction: Sweet’s syndrome characterized by fever, blood neutrophilia and inflammatory skin lesions, is rarely diagnosed in children. It presents in three clinical settings: classical Sweet’s syndrome, usually after a respiratory tract infection; malignancy-associated, frequently related to acute myelogeneous leukemia; and drug-induced. We present, to the best of our knowledge, the first case of a rotavirus -infection-related Sweet’s syndrome. Case presentation: An 18-month-old boy of Hellenic origin was referred to us with diarrhea, fever, neutrophilia, typical skin lesions, asymmetrical hip arthritis and oropharyngeal involvement. A skin biopsy confirmed the diagnosis. Thorough screening did not reveal any underlying systemic illness, except for the confirmation of an overt rotavirus infection. The syndrome responded promptly upon corticosteroid administration; no recurrence was observed. Conclusion: Besides describing the connection of Sweet’s syndrome to a rotavirus infection, this case report is also a reminder that in a child presenting with a febrile papulo-nodular rash with neutrophilia Sweet’s syndrome should be included in the differential. Introduction Sweet’s syndrome (acute febrile neutrophilic dermatosis) is characterized by a constellation of clinical symptoms and physical findings, which include fever, blood and tissue neutrophilia, leading to the development of ten- der, erythematous inflammatory skin lesions (papules, nodules, plaques), histopathologically characterized by the presence of abundant mature neutrophils [1]. It pre- sents in three clinical settings: ‘classical’ (’para-infec- tious’) Sweet’s syndrome, representing a hypersensitivity reaction preceding infection; malignancy-associated (’para-neoplastic’) Sweet’s syndrome (in children usually associated with acute myelogenous leukemia); and less frequently as an adverse drug reaction, sometimes in connection with certain underlying diseases (drug- induced Sweet’s syndrome) [2]. Irrespective of its cause, clinical and laboratory signs in Sweet’s syndrome * Correspondence: amakis@cc.uoi.gr 1Child Health Department, University of Ioannina Medical School, P.O. Box 1187, GR-45110 Ioannina, Greece Full list of author information is available at the end of the article respond promptly to systemic corticosteroids. Sponta- neous resolution is possible, although a persisting recur- rent course over months is the rule [3]. Sweet’s syndrome is rarely diagnosed in children [4]. Here, on the occasion of a child with classical, “para- infectious” Sweet’s syndrome we present, to the best of our knowledge for the first time in the accessible literature, the association of this syndrome to a rota- virus infection. The current report appends rotavirus to the list of infectious agents associated with Sweet’s syndrome, thus expanding the pertinent diagnostic cri- teria [5]. Case presentation An 18-month-old boy of Hellenic origin was initially admitted to another hospital because of fever up to 39.9°C lasting for five days, a mild cough, one to two vomits and two to three yellowish diarrheas per day. On examination, apart from fever (38.8°C) no other patholo- gical findings were present. Laboratory evaluation revealed leukocytosis (26,500/μl) with 47% neutrophils © 2010 Makis et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.