Acute Onset of Bullous Skin Rash and Acute Kidney Injury after Exposure to Radiocontrast: Sweet’s Syndrome

Sweet’s syndrome or acute febrile neutrophilic dermatosis is characterized by an acute inflammatory skin eruption of oedematous and erythematous papules, plaques or nodules, accompanied by fever, and leucocytosis with possible extracutaneous involvement. Aetiologies include infections, inflammatory bowel disease, pregnancy or malignancy, or the syndrome may be drug-induced by many classes of medications or very rarely, radiocontrast exposure. Herein, the authors report a case of radiocontrast-induced bullous Sweet’s syndrome and contrast-induced acute kidney injury in a woman in her 60s with a complex medical history. LEARNING POINTS: Patients with Sweet’s syndrome (SS) typically present with acute-onset fever, leucocytosis, and erythematous, tender plaques with dense neutrophilic infiltration in the dermis. The condition is classified into three subtypes: classic SS, malignancy-associated SS, and drug-induced SS. Drug-induced SS is characterized by an abrupt onset of a painful erythematous rash, dense neutrophilic dermal infiltrate without vasculitis, a temporal relationship between exposure and onset, and resolution of symptoms after drug discontinuation and/or corticosteroid therapy. Treatment options include systemic corticosteroids as first-line therapy, while colchicine, dapsone, indomethacin, naproxen, clofazimine, ciclosporin, α-interferon, and potassium iodide may be considered as second-line therapies in cases resistant to corticosteroids.