420. A case report of Maternal Sweet’s syndrome: A rare complication of pregnancy

A 31-year-old multiparous woman from Pakistan presented at 29 weeks gestation with arthralgia, a generalized rash and a painful breast swelling. She had high-grade pyrexia, erythema nodosum, inflammed MCP joints, conjunctivitis and a tender immobile 10 cm lesion in the left breast. The remainder of the examination including the obstetric assessment was unremarkable. Specialists in rheumatology, dermatology, microbiology, ophthalmology, breast surgery, and obstetrics reviewed the patient. Differential diagnoses included atypical tuberculosis, systemic staphylococcal infection, inflammatory arthritis, panniculitis, and paraneoplastic phenomenon. Investigations revealed a neutrophilia and a raised CRP. Screening and culture for infection and an autoimmune screen was negative. She was commenced on IV antibiotics, but with no clinical response. Skin biopsy showed neutrophilic lobular panniculitis. Breast biopsy showed prominent chronic and acute inflammation of the breast lobules with no evidence of malignancy. Following review of all histopathological results, the diagnosis of subcutaneous Sweet’s syndrome was made. The patient’s clinical condition stabilized on oral steroid therapy. However, serial fetal growth scans revealed a fall off in growth at 37 weeks gestation. An elective Caesarean section was performed and a vigorous male infant was born in good condition, weighing 2.7 kgs. Interestingly, placental histology was normal, indicating that the placenta was spared the effect of systemic inflammation. Sweet’s syndrome, also known as acute febrile neutrophilic dermatosis, is a rare inflammatory disorder characterized by acute skin changes, neutrophilia, fever and malaise. There are three subtypes: classical, malignancy-related and drug-induced. Pregnancy-associated Sweet’s syndrome is defined as classical Sweet’s syndrome with its initial presentation during pregnancy. This is another case to add to the four previously reported [1] .