Sweet’s syndrome is a neutrophilic dermatosis characterized by tender, erythematous, pseudovesicular plaques that can be associated with hematologic malignancy. We report a patient with recalcitrant Sweet’s syndrome that preceded the development of myelodysplastic syndrome by 30 months. The delay between the onset of Sweet’s syndrome and the subsequent diagnosis of myelodysplasia highlights the need for thorough and repeated evaluation for underlying malignancy in patients with such a course. Although corticosteroids are the initial treatment of choice, this patient’s eruption was only partially responsive to high-dose prednisone andwas refractory tometronidazole, dapsone, and methotrexate. Treatmentwith thalidomide resulted in complete resolution of the cutaneous lesions within one month of therapy.