A 73 year old female presented with acute onset fever and right -sided facial swelling, erythema and pain. She was initially diagnosed with facial cellulitis. The patient was placed on a course of cephalexin; however, her symptoms worsened, and she developed bilateral facial edema. Routine laboratory data was not indicative of leukocytosis. An incision and drainage was performed and minimal aspirate was retrieved; aspirate cultures were negative for bacterial and fungal growth. The patients facial swelling continued to progress; she developed bilateral peri-orbital edema, and she was intubated for airway protection. The patient's antibiotics were then broadened to vancomycin and piperacillin-tazobactam, but after Infectious disease consultation, they were changed to ampicillin-sulbactam and fluconazole. Repeat cultures performed were again negative for any microorganisms. However, her symptoms did not improve with antimicrobial therapy, so it was discontinued and a non-infectious etiology was considered more likely. Rheumatology was consulted, but the rheumatologic workup was negative. Then, Dermatology was consulted; they performed a left cheek biopsy which showed perivascular and interstitial acute and chronic inflammation of the dermis, and a diagnosis of febrile neutrophilic dermatosis was made. Consequently, she was started on high-dose corticosteroids, and her symptoms dramatically and rapidly improved.'
Huerta, S and S Modi. "Clinical vignette: An atypical case of Sweet's syndrome presenting as facial cellulitis." (2014). http://digitalrepository.unm.edu/hostpitalmed_pubs/7