Pregnancy-associated Sweet’s Syndrome in an Acute Episode of Ulcerative Colitis

Abstract

A 33-year old pregnant patient (pregnancy week 15) with a past medical history of ulcerative colitis with onset of the disease following the birth of her first child was admitted to the hospital with symptoms of weight loss, pyrexia, leukocytosis and bloody and mucous diarrhoea. Total ileocolonoscopy revealed an acute flare of ulcerative colitis. Within a few days, tender erythematous skin lesions occurred and were histologically proven to be neutrophilic dermatosis. Treatment with highly-dosed prednisone led to a complete remission of both cutaneous and intestinal manifestations. Both pathogenic entities are associated with similar immunological alterations, such as comparable cytokine and chemokine release patterns and recruitment of inflammatory cells. Recent data also indicates that proinflammatory cytokine levels are elevated in pregnancy, which might be pivotal in the pathogenesis and the severity of intestinal and extraintestinal symptoms. We present and discuss a diagnostic algorithm and an overall therapeutic rationale for Sweet's syndrome.

Pregnancy-Induced Sweet’s Syndrome Treated with Infliximab

“…The pregnancy can precede and/or can be associated with onset and/or flare-up of CD [6]. It is known that the G-CSF which is upregulated in pregnancy can directly increase the number of neutrophils in the peripheral blood, which consecutively leads to inflammatory responses [1]. Moreover, significantly elevated inflammatory parameters appear to predict a potential risk of developing SS during an acute episode of IBD [1].…”

“…In our case, both pregnancy and CD might be conditions that are linked to SS. Proinflammatory cytokines and acute phase proteins play an essential role in the pathogenesis of SS [1]. It is known that pregnancy can induce an upregulation of cytokines.…”

“…It is known that the G-CSF which is upregulated in pregnancy can directly increase the number of neutrophils in the peripheral blood, which consecutively leads to inflammatory responses [1]. Moreover, significantly elevated inflammatory parameters appear to predict a potential risk of developing SS during an acute episode of IBD [1]. However, it is unlikely that the CD caused the SS in this case, as the patient did not have recurrence of SS concurrent with a new episode of CD when not pregnant.…”

“…Immunological changes brought about by pregnancy can sensitize the immune system to elicit a secondary inflammatory reaction [1] leading to the onset or flare-up of Crohn’s disease (CD) and/or SS. Recent data have also indicated that levels of proinflammatory cytokines become elevated in pregnancy, which might prove to be pivotal in the pathogenesis and severity of intestinal and extraintestinal symptoms [2].…”

Successful treatment of ulcerative colitis complicated by Sweet’s syndrome by corticosteroid therapy and leukocytapheresis

“…Sweet's syndrome is thought to be a systemic reactive phenomenon, but the mechanism of the disease is not well understood. Although frequently observed in patients with leukemia, connective tissue disease, inflammatory disease and infection [2][3][4], Sweet's syndrome is rare in patients presenting with inflammatory bowel disease (IBD), particularly those with ulcerative colitis (UC) ( Table 1) [3,[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Here, we report a patient with active total colitis type UC with recurrence in segments of the transverse colon and concomitant Sweet's syndrome, and summarize similar cases of Sweet's syndrome complicated by UC in the English literature.…”