A case of ulcerative colitis complicated by Sweet's disease and erythema nodosum

Abstract

A 40-year-old man─who had been diagnosed ulcerative colitis on March 2011─presented at our emergency room with fever, frequent diarrhea and dizziness. At the same time, there was painful flat flare on his knee and toe. Laboratory data showed elevated white blood cell count and serum CRP. Lower GI endoscopy revealed ulcers extending from the rectum to the ascending colon. A few days later, another skin lesion suddenly appeared. The new cutaneous eruptions were severely painful pustules of a few centimeters in diameter. Both skin lesions were biopsied. The first lesion showed patchy adipose tissue inflammation, mainly comprising lymphocytes. The second lesion showed dense perivascular neutrophil infiltrates without vasculitis. The first lesion was suspected to be erythema nodule and the second, Sweet’s disease. The patient was treated with high dose prednisolone (60 mg/day) , and soon after the painful pustules disappeared. Abdominal symptoms and endoscopic findings also resolved. Searching on the Japana Centra Revuo Medicina database, we found only six reported cases of ulcerative colitis complicated by Sweet’s disease. Here we report this rare case with a combination of ulcerative colitis and Sweet’s.