Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF
Net Letter
2016:82:1;112-112
doi: 10.4103/0378-6323.162323
PMID: 26728837

Transient autoimmune thyroiditis associated with Sweet's syndrome

Renu Rattan, Abhishek Sharma, Vinay Shanker, Gita R Tegta, Ghanshyam K Verma
 Department of Dermatology, Venereology and Leprosy, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India

Correspondence Address:
Vinay Shanker
Department of Dermatology, Venereology and Leprosy, Indira Gandhi Medical College, Shimla - 171 001, Himachal Pradesh
India
How to cite this article:
Rattan R, Sharma A, Shanker V, Tegta GR, Verma GK. Transient autoimmune thyroiditis associated with Sweet's syndrome. Indian J Dermatol Venereol Leprol 2016;82:112
Copyright: (C)2016 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

Sweet's syndrome, also known as acute febrile neutrophilic dermatosis, is an inflammatory skin disorder characterized by an acute onset of painful erythematous papules, plaques or nodules. Fever and peripheral neutrophilic leucocytosis are also present. A dense neutrophilic infiltrate without evidence of primary vasculitis is seen on histopathology. It is usually associated with infections, inflammatory bowel disease, pregnancy, malignancies, autoimmune connective tissue diseases and drugs. We describe a patient with Sweet's syndrome who subsequently developed transient autoimmune thyroiditis.

A 52-year-old diabetic and hypertensive woman presented with a 5 day history of high grade fever and tender red lesions. Cutaneous examination revealed erythematous papules and nodules which were distributed over the trunk, limbs and face. These coalesced to form irregular, edematous plaques with well defined margins and pseudo-vesiculation [Figure - 1]a and [Figure - 1]b. There was no mucosal involvement. Her systemic examination was within normal limits and there was no enlargement or tenderness of the thyroid gland. There was no history suggestive of preceding infections, thyroid dysfunction, autoimmune connective tissue disease or malignancy. She was receiving olmesartan and hydrochlorothiazide for hypertension along with metformin and glimepiride for diabetes. She gave no history of any other drug intake prior to the onset of lesions.

Figure 1: (a and b) Erythematous papules and nodules at the time of presentation

Laboratory and imaging evaluation was done to establish the diagnosis of Sweet's syndrome and investigate possible associated infectious, inflammatory or neoplastic conditions. The haemogram revealed raised a total leukocyte count (14,000/mm 3), neutrophilia (75%) and a raised ESR (120 mm in first hour). The C reactive protein test was positive. Liver and renal function tests, urine and stool microscopy, chest X-ray and ultrasound of the abdomen/pelvis did not reveal any abnormality. Blood and urine cultures were sterile.

Incidentally, the patient had her thyroid function tests done on the second day of illness, which showed normal T3, T4 and TSH levels. However, a repeat thyroid function test revealed normal T3 (1.0 ng/ml), raised T4 (15.60 µg/dl), decreased TSH (0.07 mIU/ml) and markedly raised anti-TPO antibodies (>1300 U/ml). Ultrasonography of the thyroid region was normal. A thyroid scan showed minimal tracer uptake in the thyroid bed region [Figure - 2]. All these findings were suggestive of autoimmune thyroiditis.

Figure 2: Thyroid scan showing minimal uptake in the thyroid bed region

Histopathological examination of the skin biopsy showed a diffuse dense infiltrate of neutrophils involving the upper and mid dermis with edema of the papillary dermis [Figure - 3]. On the basis of clinical and histopathological findings, a diagnosis of Sweet's syndrome was made. She was treated with oral corticosteroids following which the fever subsided in two days and skin lesions in five days [Figure - 4]. The dose of corticosteroids was tapered down over the course of four weeks. Thyroid function tests were repeated after a month. The T3, T4 and TSH levels returned to normal, anti-TPO antibodies levels decreased (828 mIU/ml) and the thyroid scan showed normal uptake [Figure - 5].

Figure 3: Edema and dense neutrophilic infiltrate in the upper dermis (H and E, ×40)
Figure 4: Improvement in clinical appearance after starting corticosteroids
Figure 5: Thyroid scan after 4 weeks of treatment, showing normal uptake in the thyroid bed region

Sweet's syndrome may be idiopathic or associated with a variety of systemic disorders in about 50% of cases. These may occur either before, simultaneously or after the disease.[1],[2] Classical or idiopathic Sweet's syndrome typically affects women in the third to fifth decade of life. The disease process is postulated to result from a hypersensitivity reaction to bacterial, viral or tumor antigens. Cytokines may also have a direct or indirect role. Further evidence comes from the association of Sweet's syndrome in patients with thyroid disease.[3] The appearance of Sweet's syndrome and thyroiditis in the same patient is probably associated with the immune mediated effects of helper T-cell type 1 cytokines (IL1, IFN-γ, TNF-α).[1],[4] It could also be due to a common causative agent. Based on a literature search, we could find four cases of Sweet's syndrome associated with Hashimoto's thyroiditis.[3],[4],[5],[6],[7] Two cases of association with subacute thyroiditis have also been reported.[8],[9]

Our patient fulfilled the diagnostic criteria for Sweet's syndrome. There were no clinical or laboratory findings suggestive of pre-existing thyroiditis. Her thyroid function tests and thyroid uptake improved with treatment, and was normal at the third and sixth month of follow up. We believe that our patient developed transient thyroiditis due to Sweet's syndrome, as she had no pre-existing thyroiditis and the thyroid functions tests returned to normal after treatment. Occurrence of both these conditions could be coincidental as well. We suggest that a possibility of autoimmune thyroiditis should be kept in mind while evaluating a patient of Sweet's syndrome due to the increasing evidence of association with thyroid disease.

References
1.
Cohen Philip R, Kurzrock Razelle. Sweet's syndrome revisited: A review of disease concepts. Int J Dermatol. 2003;42:761-78.
[Google Scholar]
2.
Cox NH, Jorizzo JL, Bourke JF and Savage. Vasculitis, Neutrophilic Dermatoses and Related Disorders. In: Burns T, Breathnach S Cox N, Griffiths C, editors. Rook's Textbook of Dermatology. 8th ed. Singapore: Wiley Blackwell, 2010. p. 50.74.
[Google Scholar]
3.
Francisco CR, Patal PC, Cubillan EA, Isip-Tan IT. Sweet's syndrome associated with Hashimoto's thyroiditis. BMJ Case Rep. 2011 Aug 24;2011.
[Google Scholar]
4.
Freedberg I M, Eisen A Z, Wolff K, Austen K F, Goldsmith L A, Katz S I. Acute febrile neutrophilic dermatosis. Fitzpatrick's Dermatology in General Medicine. 2003;1:949-59.
[Google Scholar]
5.
Nakayama H, Shimao S, Hamamoto T, Munemura C, Nakai A. Neutrophilic dermatosis of the face associated with aortitis syndrome and Hashimoto's Thyroiditis. Acta Derm Venereol. 1993;73:380-1.
[Google Scholar]
6.
Medeiros S, Santos R, Carneiro V, et al. Sweet syndrome associated with Hashimoto thyroiditis. Dermatol Online J. 2008;14:10.
[Google Scholar]
7.
Saeed M, Brown GE, Agarwal A, Pellowski D, Jacks J, Liverett HK, Vyas KS. Autoimmune clustering: Sweet syndrome, Hashimoto thyroiditis, and psoriasis. J Clin Rheumatol. 2011 Mar; 17(2):76-8.
[Google Scholar]
8.
Alcalay J, Filhaber A, David M, et al. Sweet's syndrome and subacute thyroiditis. Dermatologica. 1987;174:28-9.
[Google Scholar]
9.
Kalmus Y, Kovatz S, Shilo L, et al. Sweet's syndrome and subacutethyroiditis. Postgrad Med J. 2000;76:229-30.
[Google Scholar]

Fulltext Views
162

PDF downloads
154
Show Sections