Sweet Syndrome Presenting with Features of Cellulitis Shortly after Femoral Angioplasty.

Neutrophilic dermatosis, or Sweet syndrome, is a cutaneous disorder caused by neutrophilic infiltration in the upper dermis. It has been associated with medications, infections and malignancies but to date it has not been associated with femoral arterial angioplasty or stenting. We present the case of a 75-year-old female who, after angioplasty and stent placement of the right superficial femoral artery, developed right heel pain with ulceration that did not respond to broad antibiotics. She underwent incision and drainage twice without improvement; both times produced negative cultures. She then underwent a punch biopsy by dermatology, which was consistent with acute spongiotic and other neutrophilic dermatoses. She was started on prednisone with immediate improvement of her symptoms. She was discharged to a rehabilitation centre with a prednisone taper and antibiotics. This report highlights the importance of maintaining Sweet syndrome on the differential for cellulitis as it is a rare mimicry of other infectious and non-infectious aetiologies, which are common in the perioperative space. Early treatment is crucial to improve symptoms, outcomes, healthcare cost and potentially the length of stay.

Learning points: Sweet syndrome, a rare skin condition related to neutrophil infiltration, may be triggered by angioplasty.Sweet syndrome is easily misdiagnosed as infectious conditions such as cellulitis.