Menekse Kastamoni Baskan, Süleyman Çeçen, Selçuk Akin, Mustafa Kamer
Turkish Journal of Plastic Surgery - 2026;34(3):123-126
Necrotizing Sweet syndrome (nSS) is a rare and aggressive form of acute febrile neutrophilic dermatosis. It can closely resemble necrotizing fasciitis in both clinical presentation and histopathological appearance. We report a 46-year-old woman with acute myeloid leukemia in remission who presented with rapidly progressing necrotic lesions on the abdomen, systemic inflammation, and elevated inflammatory markers. A high laboratory risk indicator for necrotizing fasciitis score led to multiple debridements and broad-spectrum antibiotics. However, the lesions continued to progress, and cultures remained sterile. Serial biopsies demonstrated dense dermal neutrophilic infiltrates without fascial necrosis, resulting in the diagnosis of nSS. Systemic corticosteroids produced rapid clinical improvement, and intravenous immunoglobulin was added due to hematologic concerns. No further debridement was required, and the patient later underwent skin grafting under controlled immunosuppression. After 5 months, complete healing was achieved with low-dose corticosteroids. This case highlights the diagnostic challenge of distinguishing nSS from necrotizing fasciitis and emphasizes the importance of early recognition, multidisciplinary care, and awareness that abdominal involvement may delay diagnosis.
