Sweet's syndrome (SS) can be triggered by inflammatory bowel disease (IBD - Crohn's disease and ulcerative colitis). When this happens, SS normally develops in response to an IBD flare, but in up to 25% of cases, it appears before the diagnosis of IBD.
This is a case of a 29-year-old man with CROHN'S disease (CD) involving the ascending colon. His condition was well controlled with mesalamine and infliximab.
The patient developed a skin RASH, and given his history of using a hot tub at the gym, he was diagnosed with hot tub FOLLICULITIS (bacterial folliculitis) and prescribed the antibiotic, oral ciprofloxacin. The rash didn't settle, and he then developed a fever, and had a raised white blood cell count, mainly comprised of neutrophils. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were elevated, indicating increased levels of inflammation in the body. The patient was diagnosed with suspected CHICKENPOX (varicella, a viral infection) and started on intravenous valacyclovir (antiviral). His condition continued to worsen, and further tests showed no evidence of viral infection.
Skin biopsy showed SS, and so the other medication was stopped. The patient was started on the steroid, prednisone, and this treatment was successful.
Huda, S. A., Kahlown, S., Jilani, M. H., Alam, S. H., Riaz, S., Vasigh, M. and Sharma, B. (2020) The Sweet syndrome as a cutaneous manifestation of Crohn’s disease. Baylor University Medical Center Proceedings, Jul; 33(3): 395–397 (PMC).