Oral Sweet's syndrome occurring in ulcerative colitis

A man aged 78 years presented with a 3-week history of tender mouth ulceration associated with arthralgia and weight loss. He had ulcerative colitis that was diagnosed 10 years previously which was well controlled on adalimumab 40 mg fortnightly. Biochemical and haematological investigations showed raised inflammatory markers (CRP 105) and a marked neutrophilia (10). On examination, the patient had severe oral ulceration involving the anterior tongue and lips. In addition, on cutaneous examination had tender erythematous nodules involving the forehead. Histology from a diagnostic punch biopsy showed marked dermal oedema with an inflammatory infiltrate consisting of neutrophils. Our working diagnosis was therefore oral Sweet's syndrome. The patient was then started on oral prednisolone and later received colchicine which led to a complete resolution of symptoms.

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