CRA25 ANTITUBERCULOUS THERAPY ASSOCIATED SWEET SYNDROME, AN UNCOMMON PRESENTATION OF A RARE DISEASE

NL Lai¹, SK Teoh¹, YW Cheah¹, YH Lim¹, JY Chan¹, SN Syed Junid Aljunid^2

1Department of Medicine, Hospital Ampang, Selangor, Malaysia
²Department of Pathology, Hospital Sultan Idris Shah Serdang, Selangor, Malaysia

Introduction
We report a case of a patient with Sweet syndrome, possibly resulting from antituberculous therapy (ATT).

Case Presentation
Mr AH is 58 year old gentleman with background of hypertension and a history of recurrent Salmonella gastroenteritis. He first reported having a plaque over his penile shaft for 3 months, which subsequently led to an extensive workup showing multiple generalised lymphadenopathy. A biopsy of his genital lesions and inguinal lymph nodes revealed granulomatous inflammation. With a strongly positive Interferon Gamma Release Assay (IGRA) test, he was diagnosed as having disseminated tuberculosis. He was commenced on ATT with Ethambutol (E), Isoniazid (H), Rifampicin (R), and Pyrazinamide (Z). However, a week later, he reported having painful plaques and patches over his upper limbs. His ATT was witheld and after an improvement in his rash, he was recommenced on HRZ therapy. However, his rashes worsened, prompting a skin biopsy which showed spongiotic dermatitis with dense dermal neutrophilic infiltrates. The patient had his ATT witheld and he was commenced on corticosteroids for Sweet syndrome. With treatment, his rashes improved. Nonetheless, he developed Salmonellosis soon after. Due to concerns of immunosuppression from systemic corticosteroids, it was decided to withold the corticosteroids. Our patient was rechallenged with E, Z and H sequentially with no recurrence of rashes.

Conslusion
Sweet syndrome has been reported as a rare association of tuberculosis. However, in our case, the patient's rash recurred with rechallenge of R and conversely, did not recur he was given an ATT regime excluding R. This suggests a possible drug trigger for Sweet syndrome as opposed to the tuberculosis itself.