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Correspondence |

Trimethoprim Sulfamethoxazole–Induced Sweet Syndrome

Rahat S. Azfar, MD; Jennifer Cohn, MD; Andras Schaffer, MD, PhD; Ellen J. Kim, MD
Arch Dermatol. 2009;145(2):215-216. doi:10.1001/archderm.145.2.215.
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Sweet syndrome (SS), or acute febrile neutrophilic dermatosis, is a hypersensitivity reaction associated with hematologic and solid malignant conditions, infection, inflammation, and, less commonly, medications. Two reports have implicated trimethoprim sulfamethoxazole (TS) in the onset of SS.1,2 Mechanistic hypotheses for drug-induced SS cite the contribution of cytokines3 or a hypersensitivity reaction.4 In cases related to granulocyte colony–stimulating factor (G-CSF) and all-trans retinoic acid (ATRA), a mechanism involving neutrophil stimulation is suggested.4 In a report of TS-induced SS, Walker and Cohen2 suggest diagnostic criteria for drug-induced SS (Table). We describe a case of TS-induced SS meeting these criteria.

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Figure 1.

Tender erythematous plaques are present on the dorsal surfaces of the hands.

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Figure 2.

Histopathologic images from the study patient (hematoxylin-eosin). Prominent superficial and deep dermal inflammation is present (A, original magnification ×20) consisting of neutrophilic infiltrates (B, original magnification ×400).

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