Sweet syndrome in a patient affected by autoimmune thyroiditis and receiving clindamycin

Abstract

Background. Sweet syndrome may be idiopathic or secondary to malignancy, autoimmune and other related inflammatory disorders, and drugs. Association with autoimmune thyroiditis is uncommon, and only in recent years a possible relationship with clindamycin has been reported. Main observations. A 46-year-old woman diagnosed of hypothyroidism one year earlier was treated with clindamycin for erysipelas affecting both legs. A few days later she became febrile, and plaques, nodules and pustules appeared in the anterior aspect of left hemithorax and shoulder. She was placed on daptomycin and levofloxacin, and erysipelas subsided, but the papulous eruption of the thorax did not, so a biopsy was performed, showing features typical of Sweet syndrome. After a short course of prednisone, 30 mg daily, papules and plaques disappeared. Antithyroglobulin and antithyroid peroxidase antibodies were both positive. Conclusion. This patient developed a Sweet syndrome in the context of an autoimmune thyroiditis, but only shortly after she received clindamycin. In 1993 the first case of autoimmune thyroiditis associated to Sweet syndrome was reported, and only a handful of cases have been reported since then; in 2007, the first case of Sweet syndrome associated to clindamycin was reported, and only one more has been published so far. Despite this, clindamycin does not appear as a drug related to Sweet syndrome in recent reviews on this illness. Temporal relationship favors the hypothesis that clindamycin was the triggering factor of Sweet syndrome in this case. Whether or not the immune alteration associated to thyroiditis also played a role is not known.