Coexistence of pyoderma gangrenosum and sweet’s syndrome in a patient with ulcerative colitis

Abstract

Pyoderma gangrenosum (PG) and Sweet's Syndrome (SS) are inflammatory skin diseases caused by the accumulation of neutrophils in the skin and, rarely, in internal organs. These neutrophilic dermatosis (NDs) are distinguished by the existence of forms of transition or overlap. They are frequently associated to systemic diseases especially hematologic and gastrointestinal ones. We report a case of a patient with ulcerative colitis (UC) who successively developed two types of NDs: PG then SS. A 66 years old patient with a history of UC consulted in July 2012 for an erythematous swelling of the back of the right hand treated with antibiotics without improvement. At that time, bacteriological samples were negative. In October 2012, he was hospitalized for polyarthralgia and impaired general condition. In physical examination, he had vesiculobullous plaque of 10 cm long of the right hand and wrist, infiltrated erythematous plaque on the right leg and another topped with a large pustule at the left ankle. Skin biopsy showed at the back of the right hand an aspect of PG and at the infiltrated plaques of the ankle an aspect of SS. Prednisone was started with improvement of the skin lesions and a recovery condition. The combination of PG and SS has already been described in cases of hematologic malignancy and rarely in UC. There is also the notion of passage from a neutrophilic dermatosis to another. Indeed, a typical lesion initially of SS can evolve to a future PG. This case demonstrates that neutrophilic dermatoses form a continous spectrum of entities that may occur in UC.

Lesions of pyoderma gangrenosum mimicking sweet's syndrome; A diagnostic dilemma

“…Some authors believe that PG and Sweet's syndrome represent a continuum of spectrum of disease. [ 7 8 ] Our finding of Sweet's-like lesion also supports this hypothesis. PG and Sweet's syndrome share many features including response to immunosuppressive therapy.…”

Sweet Syndrome: A Review of Published Cases

“…This review found that Crohn’s disease is the most common reported underlying condition in SS. The association of PG and IBD is well recognized; however, the association of SS and IBD should not be overlooked [14]. Appropriate review of systems and workup should be considered.…”

Neutrophilic Dermatosis and Management Strategies for the Inpatient Dermatologist

“…Clinical assessment should include timing of disease onset as well as a thorough review of systems to initially evaluate for conditions such as recent infection, malignancy, pregnancy, and autoimmune disease, due to their known associations with ND. Surveillance of the entire skin should be performed as the distribution of lesions of the same disease can vary between patients (e.g., cases of both proximal and distal distributions of neutrophilic eccrine hidradenitis have been described), as well as the overlap between lesions of different NDs have also been reported [ 16 ]. While the appropriate description of eruption morphology is crucial to initial differential diagnoses, clinico-pathologic correlation is essential for diagnosis and is often a major diagnostic criterion for NDs [ 4 ].…”