Accepted Article

Accepted Article
Crohn’s disease and Sweet’s syndrome: A debut together
Aida Ortega Alonso, Norberto López Navarro, Elena
Gallego, Carmen Lara, Guillermo Alcaín Martínez
DOI: 10.17235/reed.2015.3842/2015
Link: PDF
Please cite this article as: Ortega Alonso Aida, López
Navarro Norberto, Gallego Elena, Lara Carmen, Alcaín
Martínez Guillermo. Crohn’s disease and Sweet’s
syndrome: A debut together. Rev Esp Enferm Dig 2015. doi:
10.17235/reed.2015.3842/2015.
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CE 3842 inglés
Crohn’s Disease and Sweet’s syndrome: A debut together
Aida Ortega-Alonso1, Norberto López-Navarro2, Elena Gallego3, Carmen Lara1 and
Guillermo Alcaín-Martínez1
1
UGC Digestive Diseases. Instituto de Biomedicina de Málaga (IBIMA). Hospital
Universitario Virgen de la Victoria. Universidad de Málaga. CIBERehd. Málaga, Spain. 2
UGC Dermatology. Hospital Universitario Virgen de la Victoria. Málaga, Spain. 3UGC
Pathology. Hospital Universitario Virgen de la Victoria. Málaga, Spain
Corresponding author: Aida Ortega Alonso ([email protected] )
Key words: Sweet’s syndrome. Crohn’s disease.
Dear Editor:
The association of Sweet’s Syndrome (SS) and Crohn’s disease (CD) is unusual, with less
than 50 reported cases. We report a case in which these entities debut together.
Case report
A 32-year-old woman with a history of guttate psoriasis 5 years earlier, with good
response to PUVA treatment, without recent episodes. Admitted for presenting
diarrhea with 40 daily liquid stools, some with mucus, ongoing for one month. In the
last 2 weeks, there was evidence of onset of pustule-like erythematous inflammatory
lesions on plaques, on the arms and legs (Fig. 1A), associated with oral ulcer, fever and
migratory arthralgias of large joints. Laboratory results showed leukocytosis with
deviation to the left and CRP: 103 mg/L. Colonoscopy revealed patchy erythematous
areas with superficial ulcers. Colonic biopsies confirmed the presence of severe
transmural inflammatory infiltrate with eosinophils and evidence of an epithelioid
granuloma. A skin biopsy showed the presence of neutrophilic infiltrates (Fig. 1B) and
granulomas in the deep dermis (Fig. 1C), confirming the diagnosis of SS. She was
treated with ciprofloxacin, metronidazole, salazopyrin and topical steroids, with good
response.
Discussion
SS was first described in 1964 by Sweet, characterized by an abrupt onset of cutaneous
lesions consisting of painful, erythematous plaques (commonly located on hands,
arms, upper trunk, neck and face), accompanied by fever, leukocitosis with
neutrophilia and an increase of the acute phase reactants. Occasionally oral sores can
appear, and the articular involvement is common (37-51% of cases). Its characteristic
histological pattern is the presence of a dense infiltrate of neutrophils located in the
dermis, accompanied by edema, without vasculitis (1,2).
The association with CD is less common, was described for the first time by Kemmett
in 1998. Colonic involvement is practically constant, with female predominance. SS
appears concurrently with the episode of CD (75% of the cases), but only in one third
of the patients present concurrent with a first episode of CD.
The treatment with steroids has shown to be very effective in the treatment of skin
lesions which disappear without scarring. The association with metronidazole may
have an additional effect. It is useful to remind the fact that some drugs used for the
maintenance of remission in CD patients such as azathioprine, may induce SS, and this
entity must be investigated in patients with dermal lesions before initiation of this
treatment (3-8).
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Fig. 1. A. Skin lesions at the onset of the disease. B. Skin lesion biopsy. Hematoxylineosin staining. Intense neutrophilic infiltrate in superficial and medium dermis, without
affecting the epidermis. C. Skin lesion biopsy. Hematoxylin-eosin staining. Group of
histiocytes forming a granuloma in deep dermis and subcutaneous tissue.