Case of a rare association: Sweet and Crohn

Abstract

Woman of 64 years who went to the emergency room with fever,
skin lesions located in the upper limbs and feet, and headache.
She had no recent history of sore throat, cough, runny nose, abnormal vision or arthralgia. Showed erythematous and edematous
papules, with a halo of erythema and edema less pronounced,
involving the forearms and feet, and many with central ulcers. The
screening revealed mild anemia, leukocytosis with neutrophilia
and elevated CRP. She was admitted with a diagnosis of Sweet's
syndrome to investigate the etiology. A skin biopsy showed a
dense infiltrate of polymorphonuclear leukocytes (neutrophils),
confirming the diagnosis. Further laboratory tests were carried out
including myelography. After colonoscopy with biopsy, was diagnosed with Crohn's disease. Treatment with prednisolone led to
a rapid improvement of symptoms and regression of skin lesions.
The Sweet's syndrome, or acute febrile neutrophilic dermatosis,
is a rare entity. The etiology is unknown but probably results from
a hypersensitivity reaction, leading to cytokine production with
subsequent activation and infiltration by neutrophils. Crohn's
disease is one of several systemic diseases that can be the basis
of Sweet's syndrome, although associations are rare. The authors
report another case of this rare association and originality of the
case is still at the age of diagnosis of Crohn's disease.