Int J Thyroidol.  2017 May;10(1):50-55. 10.11106/ijt.2017.10.1.50.

Sweet's Syndrome Associated with Graves' Disease

• Yong HJ
• Kang MI
• Kim D

• KMID: 2379362
• DOI: http://doi.org/10.11106/ijt.2017.10.1.50

Abstract

Sweet's syndrome, or acute febrile neutrophilic dermatosis, occurs in association with autoimmune diseases such as Hashimoto's thyroiditis but is rare in Graves' disease, in which all cases are induced by propylthiouracil (PTU). We report a case of Sweet's syndrome in a patient with Graves' disease treated with methimazole (MMI) during three weeks. A 34-year-old man presented with the acute onset of high fever, skin rashes on the whole body, arthralgia, and acroparesthesia. Laboratory results showed leukocytosis and elevated C-reactive protein. MMI first stopped and antibiotics and antihistamine therapy started, but his symptoms dramatically improved after oral prednisolone. Graves' disease has again been treated by MMI because of his aggravated ophthalmopathy. After one year of retreatment with MMI, there has been no recurrence of Sweet's syndrome, supporting that Sweet's syndrome in this case was not related to MMI exposure. To our knowledge, this is the first report of Sweet's syndrome associated with Graves' disease per se but not PTU or MMI use.

Keyword

Acute febrile neutrophilic dermatosis; Anti-thyroid drugs; Graves' disease; Hashimoto's thyroiditis; Sweet's syndrome

MeSH Terms

Adult
Anti-Bacterial Agents
Arthralgia
Autoimmune Diseases
C-Reactive Protein
Exanthema
Fever
Graves Disease*
Humans
Leukocytosis
Methimazole
Prednisolone
Propylthiouracil
Recurrence
Retreatment
Sweet Syndrome*
Thyroid Gland
Thyroiditis
Anti-Bacterial Agents
C-Reactive Protein
Methimazole
Prednisolone
Propylthiouracil

Figure

• 

  Fig. 1 Clinical characteristics and laboratory results during the admission. Day 0 represents the day of admission. *,†Peak body temperature before and after the administration of oral prednisolone, respectively. AB: antibiotics, AH: antihistamines, BT: body temperature, CRP: C-reactive protein, DC: discharge, KI: potassium iodide, MMI: methimazole, OPD: outpatient department, PD: prednisolone

• 

  Fig. 2 Follow up of thyroid function tests and the dose of methimazole. The reference ranges of thyroid function tests were as follows: free T4 0.78-1.94 ng/dL (gray area), TSH 0.25-4.0 mIU/L (dash line), anti-TSH-R 0-1.5 IU/L. Adm: admission, anti-TSH-R: anti-TSH receptor antibody, free T4: free thyroxine, MMI: methimazole, TSH: thyrotropin

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