Ilias Basha Haseeb, Towfiq Basim, Krznarich Terry S
Department of Internal Medicine, Michigan State University College of Human Medicine, East Lansing, MI, USA.
Department of Internal Medicine, Hurley Medical Center, Flint, MI, USA.
J Cardiol Cases. 2012 Apr 10;6(1):e8-e12. doi: 10.1016/j.jccase.2012.03.002. eCollection 2012 Jul.
We report an unusual case of a 50-year-old female with no significant past medical history who reported with a sudden eruption of painful erythematous papules accompanied by fever. Clinical and pathological findings were consistent with acute febrile neutrophilic dermatosis (or Sweet's syndrome). Two weeks later, she complained of chest pain and was diagnosed with non-ST elevation myocardial infarction. Coronary angiogram demonstrated stenosis of right coronary artery and left Circumflex artery. Subsequent workup to identify underlying malignant or autoimmune disorders was negative. She refused to undergo percutaneous coronary intervention and was treated conservatively with steroids, resulting in dramatic resolution of skin lesions. Six months later, the patient was readmitted with similar complaints including fever, generalized rash, and chest pain. Electrocardiography demonstrated old infero-lateral wall infarction. Cardiac enzymes were not elevated. Repeat workup failed to identify underlying systemic disorder except coronary artery disease (CAD). She recovered following administration of steroids and continued to receive medical therapy for CAD. This case demonstrates an unusual association between Sweet's syndrome and CAD in an adult female. Sweet's syndrome is considered to be a reactive phenomenon of underlying systemic disorders. Therefore, patients presenting with Sweet's syndrome should be evaluated for CAD, especially in the absence of underlying malignant or autoimmune disorders.
我们报告了一例罕见病例，一名50岁女性，既往无重大病史，因突发疼痛性红斑丘疹伴发热前来就诊。临床和病理检查结果与急性发热性嗜中性皮病（或Sweet综合征）相符。两周后，她主诉胸痛，被诊断为非ST段抬高型心肌梗死。冠状动脉造影显示右冠状动脉和左回旋支狭窄。随后进行的旨在查明潜在恶性或自身免疫性疾病的检查结果均为阴性。她拒绝接受经皮冠状动脉介入治疗，采用类固醇进行保守治疗，皮肤病变显著消退。六个月后，该患者因类似症状再次入院，包括发热、全身性皮疹和胸痛。心电图显示陈旧性下侧壁心肌梗死。心肌酶未升高。除冠状动脉疾病（CAD）外，再次检查未能发现潜在的全身性疾病。给予类固醇治疗后她康复了，并继续接受CAD的药物治疗。该病例显示了成年女性中Sweet综合征与CAD之间的罕见关联。Sweet综合征被认为是潜在全身性疾病的一种反应性现象。因此，出现Sweet综合征的患者应接受CAD评估，尤其是在没有潜在恶性或自身免疫性疾病的情况下。
