A painful rash

doi:10.1136/bmj.b2293

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A painful rash

BMJ

2009; 339 doi: 10.1136/bmj.b2293 (Published 15 July 2009)

Cite this as: BMJ 2009;339:b2293

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Tanya M Monaghan, academic clinical fellow and specialist registrar1,
James D Thomas, specialist registrar2,
William Goddard, consultant gastroenterologist3

¹Institute of Infection, Immunity and Inflammation, University of Nottingham, Queen’s Medical Centre, Nottingham NG7 2UH
²Department of Radiology, Queen’s Medical Centre, Nottingham NG7 2UH
³Derby Digestive Diseases Centre, Derby City General Hospital, Derby DE22 3NE

T M Monaghan tanyamonaghan{at}gmail.com

A 54 year old man presented with a flare of Crohn’s disease. He had developed a painful red rash on his face, neck, and shoulders one week prior to this flare. Clinical examination showed multiple tender erythematous plaques with superadded pustules and surrounding erythema. Laboratory investigations showed a white cell count of 15×10⁹/l—essentially neutrophilia—and a C reactive protein concentration of 106 mg/l. Blood tests were otherwise unremarkable. The patient is shown 10 days after onset of the rash, when the lesions were beginning to resolve.⇓ ⇓

Fig 1 Frontal photograph of the patient’s forehead 10 days after the onset of the rash

Fig 2 Close up photographs of two of the facial lesions

Questions

1 What is the diagnosis?
2 What factors is this condition associated with?
3 What is the treatment?

Answers

Short answers

1 This patient has Sweet’s syndrome.
2 Sweet’s syndrome is associated with upper respiratory tract infection; gastrointestinal infection; inflammatory bowel disease; pregnancy; malignancy; and certain drugs (for example, growth factors and various antibiotics, antiepileptics, antihypertensives, antipsychotics, contraceptives, diuretics, non-steroidal agents, and retinoids).
3 The “gold standard” treatment option is a tapered dose of systemic corticosteroids (initial dose of 40-60 mg per day) over a period of 4-6 weeks.