Sweet's syndrome - An extraintestinal manifestation in inflammatory bowel disease

Background/Aims: Sweet's syndrome (SS) is a severe dermatosis that may be an extraintestinal manifestation of inflammatory bowel disease (IBD). Worldwide, 35 cases of SS associated with IBD have been reported. We present the first case of severe, recurrent SS in combination with amebic infection and ulcerative colitis complicated with multiple other extraintestinal manifestations. Methods: Disease course was monitored by serum YKL-40 and C-reactive protein (CRP), white blood cell count, albumin and the Simple Clinical Colitis Activity Index (SSCAI). The amebic infection was diagnosed by direct microscopy of wet mount scrapings sampled by repetitive sigmoidoscopies. Results: The patient was diagnosed with left-sided ulcerative colitis and SS combined with extraintestinal manifestations: arthropathies, iridocyclitis and erythema nodosum. Cysts of Entamoeba histolytica were detected in the stools in two separate periods of time. Serum YKL-40 increased prior to CRP and correlated with disease activity, SCCAI, CRP, white blood cell count and inversely with serum albumin. Conclusion: This case gives further support for SS being an extraintestinal manifestation of ulcerative colitis. YKL-40 may be useful in monitoring the disease course of IBD.