Pregnancy-associated Sweet’s Syndrome in an Acute Episode of Ulcerative Colitis

Zusammenfassung

Eine im 2. Trimenon schwangere 33-jährige Patientin (15. SSW) mit einer seit Geburt des 1. Kindes bekannten Colitis ulcerosa stellte sich in unserer Klinik aufgrund von neu aufgetretenem, progredientem Gewichtsverlust, Fieber, Leukozytose und blutig/schleimig tingierten Diarrhöen vor. Endoskopisch konnte ein akuter Schub der bekannten Colitis ulcerosa nachgewiesen werden. Wenige Tage später manifestierten sich zusätzlich kutane erythematöse Knötchen und Plaques, anhand von Hautbiopsien wurde die klinische Verdachtsdiagnose einer neutrophilen Dermatitis (Sweet-Syndrom) histologisch gesichert. Eine unverzüglich initiierte, hoch dosierte intravenöse Steroidstoßtherapie erzielte eine unmittelbare Remission, sowohl der kutanen als auch der intestinalen Manifestationen. Beide Krankheitsentitäten weisen eng miteinander assoziierte immunologische Alterationen auf. Pathogenetisch bestehen sowohl bei den Aktivierungsmustern auf Zytokin- und Chemokinebene als auch bei der Aktivierung inflammatorischer Zellreihen signifikante Parallelen. Aktuelle Daten belegen, dass es im Rahmen der Gravidität zu einer Elevation proinflammatorischer Zytokinspiegel kommen kann. Dieses Phänomen spielt möglicherweise eine Schlüsselrolle, sowohl bei der Manifestation intestinaler und extraintestinaler Symptome als auch für den Schweregrad des Krankheitsverlaufs. Im Folgenden werden ein Diagnostikalgorithmus und ein pathogenetischer Erklärungsansatz für das Sweet-Syndrom diskutiert.

Abstract

A 33-year old pregnant patient (pregnancy week 15) with a past medical history of ulcerative colitis with onset of the disease following the birth of her first child was admitted to the hospital with symptoms of weight loss, pyrexia, leukocytosis and bloody and mucous diarrhoea. Total ileocolonoscopy revealed an acute flare of ulcerative colitis. Within a few days, tender erythematous skin lesions occurred and were histologically proven to be neutrophilic dermatosis. Treatment with highly-dosed prednisone led to a complete remission of both cutaneous and intestinal manifestations. Both pathogenic entities are associated with similar immunological alterations, such as comparable cytokine and chemokine release patterns and recruitment of inflammatory cells. Recent data also indicates that proinflammatory cytokine levels are elevated in pregnancy, which might be pivotal in the pathogenesis and the severity of intestinal and extraintestinal symptoms. We present and discuss a diagnostic algorithm and an overall therapeutic rationale for Sweet’s syndrome.

Schlüsselwörter

Colitis ulcerosa - neutrophile Dermatose - Schwangerschaft - Zytokine - IL-6 - G-CSF - AFP - CRP - Inflammation

Key words

inflammatory bowel disease - neutrophilic dermatosis - pregnancy - cytokines - IL-6 - G-CSF - AFP - CRP - inflammation

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