Montero-Arias Felicia, Rojas-Varela Randall, Rodriguez-Loria Abril, Ramos-Castro Ricardo, Belilty-Montvelisky Simon, Cartin-Ceba Rodrigo
Hospital México, Department of Respiratory Medicine, Calle 10, Av. 8, San José, 10107, Costa Rica.
Hospital Clínica Bíblica, Calle Central Alfredo Volio, Between Av. 14 and 16, San José, 10101, Costa Rica.
Respir Med Case Rep. 2025 Apr 30;56:102225. doi: 10.1016/j.rmcr.2025.102225. eCollection 2025.
A 33-year-old man presented with a 1-week history of odynophagia, fever, and dyspnea. Initial chest computed tomography (CT) revealed multiple bilateral consolidations predominantly in the lower lobes. Laboratory investigations revealed leukocytosis, while cultures remained negative and the patient was started on antibiotics for suspected community-acquired pneumonia. Despite this, his condition deteriorated, with follow-up CT showing necrotizing pneumonia and cavitations. He subsequently developed violaceous papular lesions on the upper extremities, and skin biopsy confirmed Sweet syndrome, characterized by dermal neutrophilic infiltration without leukocytoclastic vasculitis. Corticosteroid therapy was initiated; however, the patient succumbed to massive hemoptysis one month after admission. This case highlights the importance of considering systemic inflammatory conditions like Sweet syndrome in the differential diagnosis of culture-negative pneumonia.
一名33岁男性，有1周的吞咽痛、发热和呼吸困难病史。初始胸部计算机断层扫描（CT）显示双侧多发实变，主要位于下叶。实验室检查显示白细胞增多，而培养结果仍为阴性，患者因疑似社区获得性肺炎开始使用抗生素治疗。尽管如此，他的病情仍恶化，后续CT显示坏死性肺炎和空洞形成。随后他上肢出现紫红色丘疹性病变，皮肤活检确诊为Sweet综合征，其特征为真皮中性粒细胞浸润而无白细胞破碎性血管炎。开始使用皮质类固醇治疗；然而，患者入院1个月后死于大量咯血。该病例强调了在培养阴性肺炎的鉴别诊断中考虑Sweet综合征等全身性炎症性疾病的重要性。
