AZATHIOPRINE INDUCED SWEET'S SYNDROME IN A PATIENT WITH CROHN’S DISEASE: A CASE REPORT

M Stapleton, R Panaccione

Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Alberta

Sweet's syndrome is a neutrophilic dermatosis which has been described as a rare exta-intestinal manifestation in patients with inflammatory bowel disease. Sweet's syndrome has been described in association with other autoimmune disorders and associated with several drugs. There has been no description in the literature of Sweet's syndrome related to the use of azathioprine.
Described is the case of a 45-year-old gentleman with a 2-year history of ileocolonic Crohn's disease. The patient developed steroid dependent disease and therefore was started on Azathioprine at 2.5 mg/kg. The patient presented at week 2 with acute onset of fever, chills, abdominal pain, and rash which was both maculopapular and pustular involving the face and trunk. Azathioprine was discontinued and infectious etiologies were ruled out. Skin biopsy was consistent with a neutrophilic dermatosis favouring Sweet's. The patient improved on high dose prednisone. The patient was discharged and azathioprine re-introduced. The patient had recurrent symptoms within 48 hours. He required readmission to hospital. The rash resolved again with glucocorticoid therapy. It reappeared with re-challenge with azathioprine.
This is the first case in the literature describing Sweet's syndrome in association with a common agent used in IBD patients. Although classically associated with IBD itself this case illustrates that drug causes should be considered. The literature of neutrophilic dermatosis in IBD is reviewed.