A child with fever presents with multiple tender erythematous skin lesions which on microscopic examination neutrophilic infiltration of the dermis. Which of the could be the possible diagnosis?
The child in the clinical scenario has presented with fever and multiple tender erythematous skin lesions and the lesions show neutrophilic infiltration in the dermis on microscopy. All of these points towards the diagnosis of Sweet Syndrome. In Behcet's syndrome the lesions are ulcerative in nature with a predominance in the oral and genital regions. The lesions show a lymphocytic infiltration in the connective tissue and not in the dermis. Pyoderma gangrenosum is a common differential diagnosis of sweet syndrome. It gives ulcerative lesions with over hanging borders and neutrophilic infiltrates. The lesions are not typically painful as in Sweet syndrome. Juvenile dermatosis commonly involve the younger children but lesions typically show vesicular or hyperkeratotic eczema with desquamation and not erythematous lesions. The histology shows hyperplasia in the stratum spinosum and paraketosis and no paicular changes in the dermis. Ref: Nelson's Textbook of Pediatrics 17th Edition, Page 833; Atlas of Dermatology in Internal Medicine By Nestor P. Sanchez, 1st Edition, Pages 68-72; Clinical Outline of Oral Pathology By Lewis R. Eversole, 4th Edition, Page 99; Sho Cases in Clinical Medicine By ABM Abdullah, 4th Edition, Pages 40-41; Textbook of Pediatric Dermatology By John Harper (MB, BS, MRCP.), John Harper, Arnold Oranje, Neil S. Prose, Volume 1, 2nd Edition, Pages 345-348; NORD Guide to Rare Disorders By National Organization for Rare Disorders, Pages 138-139
Pyoderma gangrenosum
Juvenile dermatosis
Behcet's syndrome
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