Disclosures: Eugene Palatulan, MD: No financial relationships or conflicts of interest

Case Description: A 28-year-old female with Asthma underwent sub-occipital craniectomy and telovelar approach for fenestration and decompression of dorsal medullary cyst, Chiari 1 malformation and syringobulbia. She was admitted to acute inpatient rehabilitation (AIR) with mobility impairments including a Trendelenburg gait, decreased foot clearance and excessive lateral trunk sway. One week into AIR course, we noted rashes in the posterior neck, which progressed into diffuse urticaria in the face, abdomen, and extremities. Concomitant dyspnea and progressive painful rash became a significant barrier to therapy. We suspected medication-induced delayed-hypersensitivity potentially from Celecoxib, Tizanidine and Cyclobenzaprine, which were new additions to her regimen, started postoperatively about 2 weeks before rash appearance. Benadryl, hydrocortisone cream, and on-standby epinephrine were provided. Dermatology performed a punch biopsy and administered Etanercept subcutaneously x2 for a suspected Stevens-Johnson syndrome. Final pathology revealed ichythyosis vulgaris suggestive of drug-induced Sweet’s syndrome. Cessation of offending agents and switch to triamcinolone-camphor cream controlled the hypersensitivity. As a result, she completed her AIR course and was discharged with modified independence.

Setting: Inpatient rehabilitation

Patient: see case description Assessment/

Results: see case description

Discussion: Drug-induced Sweet’s syndrome is a rare illness characterized by neutrophilic dermatosis characterized by appearance of edematous and erythematous papules, plaques, or nodules two weeks after starting new medication. In a type-IV hypersensitivity reaction, it is vitally important to review medications naïve to patient. Cessation of offending agents and initiation of corticosteroid agent is key. Of the three offending agents suspected, Celecoxib is known to cause drug-induced Sweet’s syndrome.

Conclusion: Drug-induced Sweet’s syndrome is a rare illness that may initially present as Stevens-Johnson syndrome and can be caused by various drugs such as Celecoxib which was the presumptive etiology in this case. Early detection, prompt withdrawal of offending agent and corticosteroid treatment is vital as pain/discomfort poses a barrier to patient’s acute rehabilitation.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/drug-induced-sweet-syndrome-initially-presenting-as-steven-johnsons-syndrome/