Crohn's disease is an inflammatory bowel disease associated with many extraintestinal manifestations involving multiple organs, including the skin, eyes, liver, and joints. Classic Sweet's syndrome is a cutaneous manifestation of Crohn's disease, characterized by sudden onset of painful plaques or nodules of the skin associated with fever and neutrophilia. We present a case of classic Sweet's syndrome in a patient with well-controlled Crohn's disease.

In this randomized clinical trial, 39 patients with psoriasis vulgaris were randomized in two groups. Intervention group received narrow band ultraviolet B (NBUVB)+isotretinoin (0.5 mg/kg/day), control group received NBUVB+placebo. Psoriasis Area Severity Index (PASI) scoring was recorded at baseline and weeks 4, 10, and 14. Thirty-seven patients completed the study. According to recorded PASI scores the difference between efficacies of two treatments was not significant. Complete clearing was noticed in 14 and 13 patients in intervention group and controls. The mean cumulative NBUVB dose in intervention group and controls was 29.95 ± 16.11 vs. 45.77 ± 7.72J/cm(2) (P=0.004). Isotretinoin+NBUVB can reduce number of phototherapy sessions and cumulative NBUVB dose.

Insulin edema is a rare complication of insulin therapy which has been described in known or newly diagnosed people with diabetes, following initiation or intensification of insulin treatment. Here we present a 63-year-old man with complaints of weight gain, shortness of breath, and lower extremity edema starting two weeks after the change of his insulin pump to the hybrid closed-loop insulin pump system and substitution of U-100 aspart insulin with U-500 regular insulin. Laboratory studies, imaging, and electrocardiogram (EKG) were performed to evaluate the cause of acute edema and were all normal. Hemoglobin A1C showed remarkable improvement after the pump change and the insulin pump download showed a significant increase in the amount of total daily insulin administered. With the exclusion of other causes of acute edema, the patient was diagnosed with insulin edema. He was started on spironolactone 50 mg/daily and showed a desirable improvement of edema on follow-up. This case shows that although the use of the hybrid insulin-pump system helps to obtain better control of diabetes in many patients, the rapid improvement in glycemic control may precipitate the development of insulin edema. Furthermore, the use of high concentration insulin in insulin pumps is off-label and their use might increase the rate of complications of insulin therapy including insulin edema.

Coronary subclavian steal syndrome (CSSS) is one of the rare complications of coronary artery bypass graft surgery (CABG). This phenomenon is a potential complication after left internal mammary artery (LIMA) to left anterior descending artery (LAD) CABG. A proximal stenosis of the left subclavian artery (SA) could cause retrograde flow from LIMA to left SA, which characterizes the mechanism of CSSS. We describe a unique case of recurrent CSSS in a 64year-old female who presented with one month of exertional dyspnea and acute onset chest pain. She had an extensive coronary artery disease history with CABG 15 years prior to presentation and CSSS treated with left SA stent placement nine years later. She also underwent percutaneous intervention with stents placed in the saphenous vein graft. Although electrocardiogram, cardiac enzymes, and stress test did not show any evidence of acute ischemic changes, perfusion scan detected large areas of partially reversible ischemia. Cardiac catheterization was performed, which showed in-stent restenosis of the left SA and retrograde flow from the LIMA to the left SA indicative of recurrence of CSSS. Left SA arteriogram confirmed in-stent restenosis of the left SA, which was treated with balloon angioplasty and stent placement.