Azathioprine-induced sweetʼs syndrome in Crohnʼs disease

Severe Sweet's Syndrome with Elevated Cutaneous Interleukin-1β after Azathioprine Exposure: Case Report and Review of the Literature

“…When SS occurs in such patients, IBD is the first suspected cause of the syndrome, given the well-reported association [10,15]. However, in the last few years several papers reporting a possible association between AZA and SS have been published (table 2) [4,5,6,7,8,10,11,12,13,14,15,16,17]. Interestingly, two of the cases reporting AZA-associated SS had an underlying disease other than IBD, and rechallenge of patients with AZA reproduced SS lesions in all 6 cases rechallenged, both facts providing support for a potential role of AZA as a trigger/co-factor in certain cases of SS [4,7].…”

“…A very recent review of the literature up to the 30th of May 2014 identified 16 reported cases of AZA-induced SS (table 2) [4,5,6,7,8,10,11,12,13,14,15,16,17]. Analysis of these 16 reported cases shows an age distribution upon onset ranging from 9 to 89 years, an association of AZA-induced SS with IBD in 13 of 16 cases (81%), and an onset within the first month of AZA therapy (with an average time to onset of 33 days, range 7-330) in 15 of 16 patients (94%) (table 2).…”

“…More recently azathioprine (AZA), the nitroimidazole of 6-mercaptopurine, which is widely used as a corticosteroid-sparing agent in a variety of autoimmune inflammatory diseases, has been increasingly reported as a potential cause of SS [4,5,6,7,8,9,10,11,12,13,14]. Here we report a severe case of SS associated with AZA therapy, review the literature concerning similar cases reported to date and analyze the expression of the proinflammatory cytokine interleukin-1β (IL-1β) in our patient's skin lesions.…”

Crohn's disease and Sweet's syndrome: an uncommon association

“…Good results have been published with some immunosuppressants such as tacrolimus in cases of corticosteroid refractory ulcerative colitis, or more recently, with anti-TNF agents such as infliximab, with a good clinical response (23)(24)(25). It is useful to remind the fact that some drugs used for the maintenance of remission in CD patients such as azathioprine, may cause drug-induced SS, and therefore this possibility must be investigated in patients with compatible dermal lesions following initiation of these treatments (26,27).…”

Crohn’s disease and Sweet’s syndrome: A debut together

“…The association with metronidazole may have an additional effect. It is useful to remind the fact that some drugs used for the maintenance of remission in CD patients such as azathioprine, may induce SS, and this entity must be investigated in patients with dermal lesions before initiation of this treatment (3)(4)(5)(6)(7)(8) …”