Acute postoperative dermatosis at the site of the electrocautery pad: Sweet diagnosis of a burning issue

Acute febrile neutrophilic dermatosis or Sweet's syndrome is a well-describ ed acute condition with possible paraneoplastic and inflammatory associatio ns. A case of a 49-year-old man with a prior history of Hodgkin's disease i s described, who underwent a laparotomy for operative treatment of a small intestinal stricture and therapy-refractory gastroesophageal reflux. Incide ntally, mild mesenteric lymphadenopathy was encountered, and a biopsy confi rmed the presence of a new, unrelated low-grade follicular lymphoma. Two we eks postoperatively, the patient developed a tender erythematous plaque at the site of the Bovie electrocautery pad on the proximal thigh. Over the fo llowing week, the affected area extended in size, and became markedly edema tous and infiltrated, with hemorrhagic surface studding, Multiple small pla ques, some with annular arrays of pustules, were found on the opposite lowe r extremity, the lower back, and the arms. A skin biopsy suggested the pres ence of Sweet's syndrome, and corticosteroid treatment was initiated. All c utaneous manifestations disappeared within 48 h except for the presence of postinflammatory erythema. Acute neutrophilic dermatoses have not been prev iously described in this postoperative presentation. The differential diagn ostic importance of this emergent entity and the potential for it being cau sed by surgical trauma are discussed.