Sweet's syndrome associated with norfloxacin in a prostate cancer patient.

General practitioners' self rating of skills in evidence based medicine: a validation study. The effect of changing disease risk on clinical reasoning. Sweet's syndrome associated with norfloxacin in a prostate cancer patient Sir, Acute febrile neutrophilic dermatosis, also termed Sweet's syndrome (SS), is an uncommon disease first described by Robert Sweet in 1964. 1 It is a hypersensitivity reaction in response to systemic factors, which may include malignant disease, infection, or drug exposure. Patients with malig-nancy often take several medications, and if SS develops, it can be difficult to tell whether it is drug-related or a paraneoplastic syndrome. Norfloxacin is an antibiotic from the family of fluoroquinolones with both bactericidal and bacteriostatic actions. It is effective against both Gram-positive and Gram-negative organisms, including pseudomonads, gonococci, H. influen-zae, staphylococci, streptococci, etc. It is usually prescribed for the treatment of gastrointestinal and genitourinary tract infections. 2 We report a case of SS in a patient with disseminated prostate adenocarcinoma few days after the initiation of a treatment with norfloxacin. A 66-year-old man with advanced prostate adenocarcinoma (diffuse bone metastasis diagnosed 2 years earlier), presented with fever, myalgias and a skin eruption consisting of painful red papules, with confluent plaques and some vesicles, affecting hand palms, feet and back skin over the lumbar zone. The mucous membranes were spared. He was under treatment with oral tramadol, naproxen and bicalutamide, with a monthly administration of intravenous zoledronic acid for his prostate cancer. Four days before the onset of the skin reaction, he was prescribed norfloxacin 400 mg b.i.d. because of a urinary infection. At admission, he was febrile (38,5 C), blood count showed leukocytosis with neutrophilia, and the erythrocyte sedimentation rate was high. A skin biopsy was taken, showing predominantly neutrophilic infiltration in the dermis without leukocytoclastic vasculi-tis, changes consistent with the diagnosis of SS. Discontinuation of norfloxacin and steroid therapy resulted in a rapid improvement of symptoms with clinical resolution of skin lesions after the first week of therapy. The clinical picture of SS typically consists of a patient with fever preceding an abrupt skin eruption with painful reddish or violaceous papules, plaques or nodules that may be studded with pustules. The distribution is usually asymmetric, affecting face and extremities, and lesions can coalesce into circinate plaques. Oral and conjunctival mucosa can also be involved. Systemic symptoms such as myalgias, arthralgias and headache are common, and extracutaneous manifestations such as pulmonary infiltrates, proteinuria …