Accepted Article
Transcripción
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. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. 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). References 1. Catalan-Serra I, Martin-Moraleda L, Navarro-Lopez L et al. Crohn's disease and Sweet's syndrome: An uncommon association. Rev Esp Enferm Dig 2010;102(5):331-7. DOI: 10.4321/S1130-01082010000500009 2. Fernandez-Torres RM, Castro S, Moreno A, et al. Subcutaneous histiocytoid sweet syndrome associated with Crohn disease in an adolescent. Case Rep Dermatol Med 2014;2014:954254. DOI: 10.1155/2014/954254 3. Perez Rodriguez MT, Martinez-Ares D, Martin-Granizo I, et al. Sweet's syndrome and erythema nodosum in a Crohn's disease patient. Med Clin (Barc) 2007;128:156-7. 4. Vaz A, Kramer K, Kalish RA. Sweet's syndrome in association with Crohn's disease. Postgrad Med J 2000;76(901):713-4. DOI: 10.1136/pmj.76.901.713 5. Rappaport A, Shaked M, Landau M, et al. Sweet's syndrome in association with Crohn's disease: Report of a case and review of the literature. Dis Colon Rectum 2001;44(10):1526-9. DOI: 10.1007/BF02234611 6. Treton X, Joly F, Alves A, et al. Azathioprine-induced Sweet's syndrome in Crohn's disease. Inflamm Bowel Dis 2008;14(12):1757-8. DOI: 10.1002/ibd.20518 7. Gonzalvez Perales JL, Tamarit Orti R, Ballester Fayos J et al. A case of Sweet's syndrome associated with Crohn's disease. Gastroenterol Hepatol 1997;20(3):134-7. 8. Burrows NP. Sweet's syndrome in association with Crohn's disease. Clin Exp Dermatol 1995;20(3):279-80. DOI: 10.1111/j.1365-2230.1995.tb01324.x 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.