Sweet's syndrome in a patient with Crohn's disease: a case report

<p>Abstract</p> <p>Background</p> <p>Sweet's syndrome, also known as acute febrile neutrophilic dermatosis, has been associated with malignancy, autoimmune disease and collagen vascular disease. The association of Crohn's disease and Sweet's syndrome is rare. We report a case of Sweet's syndrome in a patient with Crohn's disease.</p> <p>Case presentation</p> <p>A 63-year-old man with a history of Crohn's disease presented with one-week duration of abdominal pain, diarrhea and hematochezia. He also noticed eruption of painful skin rashes all over his body at the same time. Colonoscopy and esophagogastroduodenoscopy (EGD) showed inflammation involving different parts of the gastrointestinal tract consistent with Crohn's disease. Punch biopsy of the skin lesion was consistent with Sweet's syndrome, which has a rare association with Crohn's disease.</p> <p>Conclusion</p> <p>Crohn's disease should be excluded in patients presenting with Sweet's syndrome and diarrhea. Alternatively, Sweet's syndrome should be considered as a diagnosis when a patient with Crohn's disease develops skin lesions.</p

Prognostic factors in patients admitted to an urban teaching hospital with COVID-19 infection

Background: Severe COVID-19 infection results in a systemic inflammatory response (SIRS). This SIRS response shares similarities to the changes observed during the peri-operative period that are recognised to be associated with the development of multiple organ failure. Methods: Electronic patient records for patients who were admitted to an urban teaching hospital during the initial 7-week period of the COVID-19 pandemic in Glasgow, U.K. (17th March 2020—1st May 2020) were examined for routine clinical, laboratory and clinical outcome data. Age, sex, BMI and documented evidence of COVID-19 infection at time of discharge or death certification were considered minimal criteria for inclusion. Results: Of the 224 patients who fulfilled the criteria for inclusion, 52 (23%) had died at 30-days following admission. COVID-19 related respiratory failure (75%) and multiorgan failure (12%) were the commonest causes of death recorded. Age ≥ 70 years (p &lt; 0.001), past medical history of cognitive impairment (p ≤ 0.001), previous delirium (p &lt; 0.001), clinical frailty score &gt; 3 (p &lt; 0.001), hypertension (p &lt; 0.05), heart failure (p &lt; 0.01), national early warning score (NEWS) &gt; 4 (p &lt; 0.01), positive CXR (p &lt; 0.01), and subsequent positive COVID-19 swab (p ≤ 0.001) were associated with 30-day mortality. CRP &gt; 80 mg/L (p &lt; 0.05), albumin &lt; 35 g/L (p &lt; 0.05), peri-operative Glasgow Prognostic Score (poGPS) (p &lt; 0.05), lymphocytes &lt; 1.5 109/l (p &lt; 0.05), neutrophil lymphocyte ratio (p ≤ 0.001), haematocrit (&lt; 0.40 L/L (male)/ &lt; 0.37 L/L (female)) (p ≤ 0.01), urea &gt; 7.5 mmol/L (p &lt; 0.001), creatinine &gt; 130 mmol/L (p &lt; 0.05) and elevated urea: albumin ratio (&lt; 0.001) were also associated with 30-day mortality. On multivariate analysis, age ≥ 70 years (O.R. 3.9, 95% C.I. 1.4–8.2, p &lt; 0.001), past medical history of heart failure (O.R. 3.3, 95% C.I. 1.2–19.3, p &lt; 0.05), NEWS &gt; 4 (O.R. 2.4, 95% C.I. 1.1–4.4, p &lt; 0.05), positive initial CXR (O.R. 0.4, 95% C.I. 0.2–0.9, p &lt; 0.05) and poGPS (O.R. 2.3, 95% C.I. 1.1–4.4, p &lt; 0.05) remained independently associated with 30-day mortality. Among those patients who tested PCR COVID-19 positive (n = 122), age ≥ 70 years (O.R. 4.7, 95% C.I. 2.0—11.3, p &lt; 0.001), past medical history of heart failure (O.R. 4.4, 95% C.I. 1.2–20.5, p &lt; 0.05) and poGPS (O.R. 2.4, 95% C.I. 1.1–5.1, p &lt; 0.05) remained independently associated with 30-days mortality. Conclusion: Age ≥ 70 years and severe systemic inflammation as measured by the peri-operative Glasgow Prognostic Score are independently associated with 30-day mortality among patients admitted to hospital with COVID-19 infection