An extremely rare association of Sweet's syndrome with active pulmonary tuberculosis

Sweet's syndrome is a skin manifestation of various systemic infections, drugs, malignancies and autoimmune disorders. There are very few case reports describing the relationship between Sweet's syndrome and non-tubercular mycobacterium infection. Further development of Sweet's syndrome secondary to mycobacterium tuberculosis (active pulmonary tuberculosis) is extremely uncommon and this is the second well established case reported from India. Here we report a forty eight year old man who presented with multiple erythematous and tender plaques over neck, palms and sides of soles. He also had high grade fever, headache, myalgias, cough, chest pain and difficulty in breathing. With clinical possibilities of (1) Sweet's syndrome with pulmonary involvement and (2) Sweet's syndrome secondary to pulmonary infection, we send the skin biopsy for histopathological examination and also advised routine laboratory plus imaging investigations to find out the underlying cause. Clinical and lab parameters together with the biopsy report fulfilled the diagnostic criteria for Sweet's syndrome. Further chest X-ray findings, demonstration of acid fast bacilli of mycobacterium tuberculosis on sputum smear microscopy and MGIT report confirmed the diagnosis of pulmonary tuberculosis. Patient was put on colchicine and standard anti-tubercular drugs. Significant improvement was noticed in skin lesions within five days of treatment and no recurrence has been seen for the past six months.