Coexistence of pyoderma gangrenosum and sweet's syndrome in a patient with ulcerative colitis.
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.
Department of Internal Medicine, Military Hospital of Tunis, 1008 Montleury, Tunisie.
Faida
F
Ajili
Department of Dermatology, Military Hospital of Tunis, 1008 Montleury, Tunisie.
Asmahan
A
Souissi
Department of Anatomopathology, Military Hospital of Tunis, 1008 Montleury, Tunisie.
Fathi
F
Bougrine
Department of Internal Medicine, Military Hospital of Tunis, 1008 Montleury, Tunisie.
Najah
N
Boussetta
Department of Internal Medicine, Military Hospital of Tunis, 1008 Montleury, Tunisie.
Nadia Ben
NB
Abdelhafidh
Department of Internal Medicine, Military Hospital of Tunis, 1008 Montleury, Tunisie.
Sameh
S
Sayhi
Department of Internal Medicine, Military Hospital of Tunis, 1008 Montleury, Tunisie.
Bassem
B
Louzir
Department of Dermatology, Military Hospital of Tunis, 1008 Montleury, Tunisie.
Nejib
N
Doss
Department of Internal Medicine, Military Hospital of Tunis, 1008 Montleury, Tunisie.
Janet
J
Laabidi
Department of Internal Medicine, Military Hospital of Tunis, 1008 Montleury, Tunisie.
Salah
S
Othmani
D000368:Aged; D001706:Biopsy; D003093:Colitis, Ulcerative / Q000150:complications* / Q000503:physiopathology; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D011241:Prednisone / Q000627:therapeutic use; D017511:Pyoderma Gangrenosum / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D016463:Sweet Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology
D005938:Glucocorticoids; D011241:Prednisone
Pyoderma gangrenosum; neutrophilic dermatosis; sweet′s syndrome; ulcerative colitis