P14 Bullous sweet syndrome as a presentation of chronic myelogenous leukaemia

A variety of cutaneous lesions are frequently encountered in clinical practice that could be secondary to allergic reactions, infections or an underlying systemic illness, including malignancy. Some of the most commonly observed paraneoplastic dermatological manifestations include acanthosis nigricans, necrolytic migratory erythema, acrodermatitis paraneoplastica, exfoliative erythroderma, paraneoplastic pemphigus, pyoderma gangrenosum and Sweet syndrome. Sweet syndrome is a neutrophilic dermatosis characterized by a particular constellation of clinical symptoms, signs and histopathological findings: pyrexia; peripheral leucocytosis; and painful erythematous skin lesions (papules, plaques and nodules) that typically reveal a dense dermal neutrophilic infiltrate and dramatic recovery of both symptoms and physical findings following treatment with systemic corticosteroids. Sweet syndrome is frequently related to malignancies and chronic inflammatory disorders, and it can also be caused by drugs. It can also be triggered by past infections or during pregnancy. We present a case of bullous variant of Sweet syndrome associated with chronic myelogenous leukaemia (CML) where the patient presented with crusted bullae and tender erythematous crusted plaques on all four limbs and face. Investigations revealed leucocytosis with peripherally circulating blasts, myelocytes and metamyelocytes. Skin biopsy revealed Sweet syndrome and bone marrow biopsy confirmed evidence of CML in the accelerated phase. The skin lesions, which had previously been resistant to therapy, surprisingly disappeared within 3 days of initiating systemic corticosteroids. In this case, the skin lesions were a crucial clinical finding in detecting and treating the underlying CML. Because of the early intervention, our patient had a good outcome.