CHEST Guidelines-A-68-Year-Old-Man-With-Skin-Rash-and-a-Pleural-Eff (1)

A-68-Year-Old-Man-With-Skin-Rash-and-a-Pleural-Eff (1)

Pdf Summary

A 68-year-old man presented with a month-long history of a spreading, itchy skin rash, fever, night sweats, fatigue, shortness of breath, and a dry cough. He has a medical history of relapsing polychondritis and was using infliximab and low-dose prednisone as treatments. Initial treatments with topical steroids and azithromycin showed no improvement. <br /><br />Physical examination revealed an erythematous, papular rash predominantly on his thighs, trunk, and feet. He had diminished breath sounds on the right lung base but was otherwise stable. Lab tests showed elevated inflammatory markers, while blood cultures and serology for infections were negative. A chest X-ray found a unilateral pleural effusion. Thoracentesis revealed a mixed lymphocytic and eosinophilic exudate without specific infection or malignancy indications. A skin biopsy indicated neutrophilic dermatitis, confirming Sweet syndrome with pulmonary involvement. <br /><br />Sweet syndrome, also called acute febrile neutrophilic dermatosis, is a rare inflammatory disorder that can occur in contexts such as infections, autoimmune diseases, and malignancies. It may also present with pulmonary symptoms, such as pleural effusions, although this is rare. Treatment usually involves glucocorticoids, which the patient responded to following an increase in prednisone and the introduction of leflunomide.<br /><br />The case highlights the importance of considering Sweet syndrome in differential diagnoses for patients presenting with unexplained skin eruptions and pleural effusions. Confirmation of SS typically requires a combination of clinical presentation and skin biopsy findings. Treatment response and prognosis can vary based on the underlying cause, such as drug-induced or malignancy-associated Sweet syndrome.

Keywords

Sweet syndrome

acute febrile neutrophilic dermatosis

pulmonary involvement

pleural effusion

neutrophilic dermatitis

relapsing polychondritis

glucocorticoids

infliximab

prednisone

skin biopsy