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Sweet Syndrome and Pulmonary Tuberculosis in a Crohn’s Disease Patient Treated with Anti-TNFα
Daniel Trabulo*, Cristina Teixeira, Suzane Ribeiro, Cláudio Martins, Joao Mangualde, Fatima Augusto, Isabelle Cremers and Ana Paula OliveiraGastroenterology Department, Hospital de Sao Bernardo, Centro Hospitalar de Setúbal, E.P.E. Setúbal, Rua Camilo Castelo Branco, 2910-446, Setúbal, Portugal
- *Corresponding Author:
- Dr. Daniel Trabulo
Gastroenterology department
Hospital de São Bernardo – Centro Hospitalar de Setúbal
Rua Camilo Castelo Branco 2910-446 Setúbal, Portugal
Tel: 00351968148206
E-mail: danieltrabulo@yahoo.com
Received date: February 23, 2015; Accepted date: March 1, 2015; Published date: March 10, 2015
Citation: Trabulo D, Teixeira C, Ribeiro S, Martins C, Mangualde J, et al. (2015) Sweet Syndrome and Pulmonary Tuberculosis in a Crohn’s Disease Patient Treated with Anti-TNFα. J Gastrointest Dig Syst 5:262. doi:10.4172/2161-069X.1000262
Copyright: ©2015 Trabulo D, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
A 36-year-old man with Crohn’s Disease (CD), under infliximab therapy, was admitted with fever and skin lesions on the face, trunk and upper limbs. Skin biopsy was consistent with Sweet Syndrome (SS). He was treated with corticosteroids, with transient clinical improvement, but without healing of skin lesions. After 2 weeks, the fever relapsed and the patient complained of night sweats. Chest X-ray and CT-scan revealed pulmonary diffuse micronodular pattern with a condensation suggestive of pulmonary tuberculosis. Tuberculin test and IGRA were positive. Bronchoalveolar lavage culture was positive for M. tuberculosis. The patient started anti-tuberculosis standard regimen and discontinued anti-TNFα therapy. During treatment, there was clinical and radiological worsening and development of CD flare. We admitted an immune reconstitution inflammatory syndrome and anti- TNFα was reintroduced after 2 months, with improvement in CD symptoms, complete healing of skin lesions and resolution of TB. To our knowledge, this is the first case reported in the literature that presents the association between SS and pulmonary tuberculosis in a patient on anti-TNFα treatment for CD, complicated with IRIS. Early recognition of this association is essential for a effective treatment. Diagnosis and therapy of SS and pulmonary tuberculosis in a patient with CD are herein discussed.
