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

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

Pdf Summary

A 68-year-old man presented with an erythematous, papular, pruritic rash initially on his right thigh, which spread to other body parts, coupled with fevers, night sweats, fatigue, shortness of breath, and a dry cough. Despite treatment with triamcinolone cream for the rash and azithromycin for presumed pneumonia, his symptoms persisted. His medical history included relapsing polychondritis, treated with infliximab and low-dose prednisone. Notably, he had diminished breath sounds at the right lung base, and a rash was observed on his right thigh and foot during examination.<br /><br />Diagnostic tests showed a unilateral pleural effusion, identified via chest radiograph, with no parenchymal infiltrates. Thoracentesis revealed a mixed lymphocytic and eosinophilic exudate, and a skin biopsy indicated superficial neutrophilic dermatitis. After evaluating various possible causes, including infectious, malignant, and inflammatory etiologies, the diagnosis was confirmed as Sweet syndrome (SS) with pulmonary involvement linked to relapsing polychondritis. <br /><br />SS, or acute febrile neutrophilic dermatosis, is a rare inflammatory disorder often associated with skin lesions and involves different contexts of manifestation such as classical, malignancy-associated, and drug-induced forms. Pulmonary involvement, though rare, can present with pleural effusions and other respiratory symptoms. Diagnosis relies on clinical and pathological criteria, with treatment mainly involving glucocorticoids.<br /><br />The patient showed rapid symptom improvement upon increasing prednisone dosage and initiating leflunomide. This case emphasizes the need to consider SS in differential diagnoses of patients with unexplained rashes and pleural effusions, highlighting the role of skin biopsies in diagnosis and the potential for various underlying conditions that could manifest similarly.

Keywords

Sweet syndrome

relapsing polychondritis

pleural effusion

neutrophilic dermatosis

pulmonary involvement

glucocorticoids

skin biopsy

erythematous rash

lymphocytic exudate

prednisone