Clinical background

A 60-year-old woman, whose only medical history was Hashimoto's thyroiditis, with no history of malignancy or immunosuppressive treatment, underwent cervicofacial rhytidectomy with SMAS plication combined with lower blepharoplasty and lower eyelid lipofilling.

The procedure was uneventful, and the immediate postoperative course was satisfactory until postoperative day 2, when the patient developed painful malar and cervical erythema (Fig. 1), associated with moderate fever (38°C). Her primary surgeon prescribed empiric antibiotic therapy with Amoxicillin/clavulanic acid for suspected infectious cellulitis.

Fig. 1: Clinical photographs (frontal and bilateral oblique views) showing characteristic erythematous infiltrated facial and cervical plaques of Sweet syndrome.

The absence of improvement and the rapid progression of the lesions into edematous erythematous-violaceous plaques led to her hospitalization on postoperative day 6 in our referral center. On admission, clinical examination revealed infiltrated erythematous plaques, painful on palpation, involving the malar, cervical, dorsal, and upper chest regions, without fluctuation or purulent discharge. There was no skin necrosis or wound dehiscence.

Body temperature was 38°C, with a white blood cell count of 9.03 G/L and elevated C Reactive protein at 75 mg/L. Bacteriological, virological, blood, and skin samples were obtained and all returned negative. Histologic examination of a skin biopsy showed a dense dermal infiltrate of neutrophils without leukocytoclastic vasculitis, confirming the diagnosis of Sweet syndrome.

Systemic oral corticosteroid therapy was initiated at a dose of 1 mg/kg/day, resulting in clinical improvement within 48 hours, with resolution of fever and progressive regression of the plaques. No additional surgical intervention was required. The scars remained supple, without dehiscence or signs of infection. At three-month follow-up, the patient showed complete healing, a satisfactory aesthetic outcome, and no recurrence (Fig. 2).

Fig. 2: Clinical photographs 3 months after onset of Sweet syndrome showing marked resolution of facial and cervical lesions.