{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T09:22:33Z","timestamp":1788340953491,"version":"build-2803163510"},"reference-count":13,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000},"content-version":"vor","delay-in-days":244,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Hematology"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>Sweet\u2019s syndrome, or acute febrile neutrophilic dermatosis, is a rare inflammatory condition that may occur idiopathically or in association with malignancy, drugs, or systemic disease. Among malignancy\u2010associated cases, hematologic neoplasms predominate. Its bullous variant is uncommon and is more frequently linked to underlying hematologic disorders, where it may act as a paraneoplastic manifestation or an early marker of disease progression. We report a 54\u2010year\u2010old woman with long\u2010standing, low\u2010risk essential thrombocythemia, diagnosed in 2011 and maintained on hydroxyurea and aspirin with stable blood counts for over a decade. She presented with an acute onset of painful erythematous swellings progressing to tense bullae over the hands and feet, accompanied by intermittent fever. Histopathological examination of a skin biopsy demonstrated dense neutrophilic infiltration of the dermis without vasculitis, consistent with Sweet\u2019s syndrome. Systemic corticosteroid therapy led to rapid clinical improvement, and hydroxyurea was discontinued. Given the known association between Sweet\u2019s syndrome and hematologic disease progression, further evaluation was undertaken. Bone marrow examination and cytogenetic analysis revealed a complex karyotype, while next\u2010generation sequencing identified an acquired TP53 mutation along with a CALR mutation, indicating clonal evolution and progression to a high\u2010risk disease state. This case highlights bullous Sweet\u2019s syndrome as a rare but important cutaneous marker of clonal evolution in essential thrombocythemia. New\u2010onset neutrophilic dermatoses in patients with previously indolent myeloproliferative neoplasms should prompt dermatologic evaluation and comprehensive hematologic reassessment, as early recognition may facilitate timely diagnosis of disease progression and guide management.<\/jats:p>","DOI":"10.1155\/crh\/9919558","type":"journal-article","created":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T08:56:30Z","timestamp":1788339390000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cutaneous Clue to Clonal Evolution: Sweet\u2019s Syndrome Heralding Hematologic Progression in Essential Thrombocythemia"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6311-4676","authenticated-orcid":false,"given":"Kavya","family":"Ronanki","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9003-8082","authenticated-orcid":false,"given":"Bibhant","family":"Shah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5728-2700","authenticated-orcid":false,"given":"Prisla Maria","family":"Dalton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8713-8060","authenticated-orcid":false,"given":"Nikhil","family":"Nagpal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5820-8174","authenticated-orcid":false,"given":"Kartik","family":"Saini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6919-4083","authenticated-orcid":false,"family":"Sushantika","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3178-2039","authenticated-orcid":false,"given":"Nilotpal","family":"Chowdhury","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7762-803X","authenticated-orcid":false,"given":"Uttam Kumar","family":"Nath","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,2]]},"reference":[{"key":"e_1_2_12_1_2","doi-asserted-by":"publisher","DOI":"10.1186\/1750-1172-2-34"},{"key":"e_1_2_12_2_2","doi-asserted-by":"publisher","DOI":"10.3892\/ijo.2013.1874"},{"key":"e_1_2_12_3_2","volume-title":"StatPearls [Internet]","author":"Vashisht P.","year":"2025"},{"key":"e_1_2_12_4_2","unstructured":"JAMA Dermatology | JAMA Network Vascular Inflammation (Vasculitis) in Sweet syndrome: A Clinicopathologic Study of 28 Biopsy Specimens From 21 Patients | Allergy and Clinical Immunology"},{"key":"e_1_2_12_5_2","doi-asserted-by":"publisher","DOI":"10.3390\/life13030809"},{"key":"e_1_2_12_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.adengl.2016.05.021"},{"key":"e_1_2_12_7_2","unstructured":"Acute Febrile Neutrophilic Dermatosis (Sweet Syndrome): Background Pathophysiology Etiology 2025 https:\/\/emedicine.medscape.com\/article\/1122152-overview?utm_source=chatgpt.com%26form=fpf."},{"key":"e_1_2_12_8_2","volume-title":"Advances in the Diagnosis and Treatment of Myeloproliferative Neoplasms (MPNs)\u2013PMC"},{"key":"e_1_2_12_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.lrr.2013.06.001"},{"key":"e_1_2_12_10_2","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2017.230"},{"key":"e_1_2_12_11_2","doi-asserted-by":"crossref","unstructured":"Molecular and Clinical Insights Into TP53-Mutated MDS and AML 2025 https:\/\/www.mdpi.com\/1422-0067\/26\/22\/10818.","DOI":"10.3390\/ijms262210818"},{"key":"e_1_2_12_12_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-020-1008-z"},{"key":"e_1_2_12_13_2","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2025.1655486"}],"container-title":["Case Reports in 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