Makis et al. Journal of Medical Case Reports 2010, 4:281 http://www.jmedicalcasereports.com/content/4/1/281 epithelium, especially IL-8 and GM-CSF, which could explain the way by which this infection probably con- tributed to the induction of the Sweet’s syndrome in our patient [14]. Conclusions In conclusion, besides reporting the association between a rotavirus infection and Sweet’s syndrome in a child, our case report is also a reminder that the differential diagnosis of a febrile child with a papulo-nodular rash and blood neutrophilia should always include Sweet’s syndrome. In such cases thorough search for common infectious causes and complete examination for extracu- taneous manifestations are mandatory and, after con- firming the diagnosis, a step-by-step examination to rule out underlying malignancy is warranted. We think that our report of the correlation of the syndrome with rota- virus infection is important, as isolation of specific cau- sative agents may help in revealing the pathophysiology of this probably underdiagnosed syndrome. Appendix Diagnostic criteria for classical Sweet’s syndrome (originally proposed by Su and Liu in 1986 and mod- ified by von den Driesch in 1994) [4,5]. For the establishment of the diagnosis of the syndrome two major and two of the four minor criteria are required. Major criteria: 1. Abrupt onset of tender erythematous plaques or nodules; 2. Dense neutro- philic infiltrate of the dermis without leukocytoclas- tic vasculitis. Minor criteria: 1. Fever of over 38°C; 2. Preceding respiratory or gastrointestinal infection or vaccination or association with an hematologic or another malignancy, inflammatory disease or preg- nancy; 3. Three of the following four laboratory find- ings ESR > 20 mm/1st hour, leukocytes > 8.000/μl, neutrophils > 70%, positive CRP; 4. Excellent response to systemic corticosteroids or potassium iodide. Conditions associated with Sweet’s syndrome in children: upper respiratory tract illness, gastrontest- inal infection, acute myelogenous leukemia, acute lymphoblastic leukemia, myelodysplastic syndrome, Fanconi’s aplastic anaemia, congenital dyserythro- poietic anaemia, aseptic meningitis, Behchet’s disease, Takayasu arteriitis, systemic lupus erythema- tosus, ulcerative colitis, T-cell or humoral immuno- deficiency, human immunodeficiency virus infection, chronic granulomatous disease, drugs (G-CSF, reti- noic acid). Consent Written informed consent was obtained from the par- ents of the patient for publication of this case report Page 6 of 6 and accompanying images. A copy of the written con- sent is available for review by the Editor-in-Chief of this journal. Author details 1Child Health Department, University of Ioannina Medical School, P.O. Box 1187, GR-45110 Ioannina, Greece. 2Department of Pathology, University Hospital of Ioannina, Niarchou str, GR-45500, Ioannina, Greece. 3Department of Dermatology and Venereal Diseases, University Hospital of Ioannina, Niarchou str, GR-45500, Ioannina, Greece. Authors’ contributions AM analyzed and interpreted the patient data and wrote the manuscript. SS was a major contributor in writing the manuscript. NC analyzed the patient data regarding the hematological and infection problems. AZ performed the histological examination of the skin. APV contributed in the writing of the manuscript. GG contributed in the differential diagnosis and interpretation of the data. AS supervised the patient’s clinical course and contributed to the differential diagnosis and interpretation of the data. IDB supervised the patient’s clinical course and was a major contributor in writing the manuscript. All authors read and approved the final manuscript Competing interests The authors declare that they have no competing interests. Received: 1 March 2010 Accepted: 20 August 2010 Published: 20 August 2010 References 1. Sweet RD: An acute febrile neutrophilic dermatosis. Br J Dermatol 1964, 76:349-356. 2. Cohen PR: Sweet’s syndrome–a comprehensive review of an acute febrile neutrophilic dermatosis. Orphanet J Rare Dis 2007, 2:34. 3. von den Driesch P: Sweet’s syndrome (acute febrile neutrophilic dermatosis). J Am Acad Dermatol 31:535-556, quiz 557-560. 4. Hospach T, von den Driesch P, Dannecker GE: Acute febrile neutrophilic dermatosis (Sweet’s syndrome) in childhood and adolescence: two new patients and review of the literature on associated diseases. Eur J Pediatr 2009, 168:1-9. 5. Su WP, Liu HN: Diagnostic criteria for Sweet’s syndrome. Cutis 1986, 37:167-174. 6. Halpern J, Salim A: Pediatric sweet syndrome: case report and literature review. Pediatr Dermatol 2009, 26:452-457. 7. 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Ramig RF: Pathogenesis of intestinal and systemic rotavirus infection. JVirol 2004, 78:10213-10220. doi:10.1186/1752-1947-4-281 Cite this article as: Makis et al.: Acute febrile neutrophilic dermatosis (Sweet’s syndrome) in a child, associated with a rotavirus infection: a case report. Journal of Medical Case Reports 2010 4:281.