Abstract
BackgroundSweet's syndrome, also known as acute febrile neutrophilic dermatosis, has been associated with malignancy, autoimmune disease and collagen vascular disease. The association of Crohn's disease and Sweet's syndrome is rare. We report a case of Sweet's syndrome in a patient with Crohn's disease.Case presentationA 63-year-old man with a history of Crohn's disease presented with one-week duration of abdominal pain, diarrhea and hematochezia. He also noticed eruption of painful skin rashes all over his body at the same time. Colonoscopy and esophagogastroduodenoscopy (EGD) showed inflammation involving different parts of the gastrointestinal tract consistent with Crohn's disease. Punch biopsy of the skin lesion was consistent with Sweet's syndrome, which has a rare association with Crohn's disease.ConclusionCrohn's disease should be excluded in patients presenting with Sweet's syndrome and diarrhea. Alternatively, Sweet's syndrome should be considered as a diagnosis when a patient with Crohn's disease develops skin lesions.
Highlights
Sweet's syndrome, known as acute febrile neutrophilic dermatosis, has rarely been associated with Crohn's disease
Crohn's disease should be excluded in patients presenting with Sweet's syndrome and diarrhea
Sweet's syndrome should be considered as a diagnosis when a patient with Crohn's disease develops skin lesions
Summary
Sweet's syndrome, known as acute febrile neutrophilic dermatosis, has rarely been associated with Crohn's disease. The rashes were nonpruritic and had started on the dorsum of his hands and spread to involve his face, neck, chest and legs He denied using any new creams, soaps, detergents or perfumes or any change in his bed sheets or clothing. Other laboratory tests, which included fungal serology, potassium hydroxide mount, gram stain, acid fast bacilli smear, bacterial culture, fungal culture and an acid fast culture of the skin rash, were all negative He was started empirically on intravenous vancomycin for possible Methicillin Resistant Staphylococcus Aureus folliculitis, pending the results of investigations. A punch biopsy of one of the skin lesions revealed dense dermal infiltrate composed predominantly of neutrophils, with no evidence of vasculitis This was consistent with the diagnosis of Sweet's syndrome. The patient's symptoms and rash rapidly improved with systemic corticosteroid treatment
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