Pleural effusion in Sweet's syndrome - Sweet's Syndrome UK

Sweet's Syndrome UK

488 members298 posts

Pleural effusion in Sweet's syndrome

Shell567 profile image
Shell567AdministratorSweet's Syndrome UK
1 Reply

[CASE-STUDY] A 68-Year-Old Man With Skin Rash and a Pleural Effusion.

- 68-year-old man with an itchy red rash on right thigh which later spread to extremities and trunk.

- Fevers of > 38.3°C, night sweats, fatigue, shortness of breath, and a dry cough.

- Prescribed triamcinolone 0.1% cream (steroid cream) for his rash and azithromycin (antibiotic) for PRESUMED PNEUMONIA, with no improvement in symptoms.

- History of relapsing polychondritis (rare disease which causes inflammation of the cartilage, and can affect lungs) for which he was prescribed infliximab (immunosuppressant) and low-dose prednisone (steroid).

- Blood tests showed raised ESR and CRP, indicating increased levels of inflammation in the body

- Chest imaging revealed a pleural effusion (collection of fluid next to the LUNG). A sample of fluid from the lung showed a mixed lymphocytic and eosinophilic exudate (white blood cells - 875 total cells, 2% polymorphonuclear neutrophils, 45% lymphocytes, and 30% eosinophils).

- Skin biopsy showed SWEET'S SYNDROME (SS).

- Prednisone (main treatment for SS) was increased from 7.5 mg/d to 20 mg/d, and leflunomide (immunosuppressant) was started, with rapid improvement of both the respiratory and skin symptoms.

Multiorgan involvement in SS can include: encephalitis, myocarditis, alveolitis, pleural effusions, hepatitis, small and large bowel inflammation, and glomerulonephritis.

Patients with pulmonary SS (affecting lungs) have reported nonproductive cough and shortness of breath, "and chest imaging has revealed parenchymal infiltrates, nodules, and pleural effusions. When performed, results of lung biopsy have shown neutrophilic alveolar infiltrates."

"Pleural effusions associated with SS are rare...thus, it is difficult to identify a predominant cellular pattern that is seen with the syndrome."

Stiller, R. H., Gadzhiev, M., Schachtel, A. K., Chang, O.H., Bastawrous, S., Shantz, H. H., Matute-Bello, G. and Albert, T. J. (2020) A 68-Year-Old Man With Skin Rash and a Pleural Effusion. CHEST JOURNAL, JUL;158(1):e33-e36.

journal.chestnet.org/articl...

Written by
Shell567 profile image
Shell567
Administrator
To view profiles and participate in discussions please or .
Read more about...
1 Reply
Shell567 profile image
Shell567AdministratorSweet's Syndrome UK

Pulmonary SS (SS affecting the lungs) is often misdiagnosed as bacterial pneumonia.

Not what you're looking for?

You may also like...

Coronavirus - COVID 19

SS patients may find it harder to recover from COVID 19, and there could be an increased risk of...
Shell567 profile image
Administrator

[CASE-STUDY] Infantile histiocytoid Sweet syndrome without an underlying systemic association, OCT 2021

"Pediatric Sweet syndrome is rare, accounting for an estimated 5% to 8% of all Sweet syndrome...
Shell567 profile image
Administrator

Sweet's syndrome paper - help needed. Please share your patient experiences.

Hi all, Kristin Langan is a doctoral nurse practitioner student at Rutgers University in the US....
Shell567 profile image
Administrator

An Introduction to Sweet's syndrome - links to information (pinned post)

Sweet’s syndrome is an autoinflammatory (not autoimmune) condition and form of neutrophilic...
Shell567 profile image
Administrator