Pregnancy-associated Sweet’s syndrome

Updated 4/11/18.

Can Sweet’s syndrome be triggered by pregnancy?

Yes, but it’s very rare, and only 2% of cases of Sweet’s syndrome have been associated with pregnancy (Chebbi and Josephine, 2014). In Oct 2018, the variant, subcutaneous Sweet’s syndrome, was reported in a 31-year-old woman from Pakistan (Byrne et al, 2018). She was 29 weeks pregnant and had developed a fever, general rash, painful breast swelling and a lesion on her left breast – originally misdiagnosed as mastitis and treated with antibiotics – joint pain and inflammation of her knuckles and Achilles tendons, and conjunctivitis. Repeat fetal growth scans revealed a fall off in growth at 37 weeks, and a Caesarean section was performed. A healthy baby boy was born in good condition, weighing 2.7 kgs/just under 6 lbs. Placental histology was normal showing no changes within the placental tissue, and the placenta had not been affected by the Sweet’s syndrome and increased levels of inflammation within the mother’s body.

Is pregnancy-associated Sweet’s syndrome being under-reported or under-diagnosed?

Possibly, due to:

  • A lack of awareness and knowledge of pregnancy-associated Sweet’s syndrome.
  • The variability of symptoms and different lesion types.
  • Pregnancy affecting blood results (Serrano-Falcón and Serrano-Falcón, 2010: 559). This means that the blood results of someone with pregnancy-associated Sweet’s syndrome might show something different from what you would normally expect to find.

Can pregnancy-associated Sweet’s syndrome be confused with other skin conditions?

Yes, it may be confused with urticarial vasculitis, eosinophilic panniculitis, and herpes gestationis (Serrano-Falcón and Serrano-Falcón, 2010: 558).

What causes pregnancy-associated Sweet’s syndrome?

Pregnancy-associated Sweet’s syndrome may be linked to:

  • Hormonal changes and increased progesterone or oestrogen levels (Serrano-Falcón and Serrano-Falcón, 2010: 558).
  • Changes within the immune system that make it more likely that an inflammatory response will occur – includes increased levels of proinflammatory cytokines (molecular messengers that promote inflammation) (Smolovic et al, 2018). In pregnancy, the cytokines granulocyte colony-stimulating factor (G-CSF) and interleukin-6 (IL-6) have been shown to play a crucial role in both intestinal and skin inflammation.

What are the symptoms of pregnancy-associated Sweet’s syndrome?

Read about the symptoms of Sweet’s syndrome here.

How  is it diagnosed?

Read about how Sweet’s syndrome is diagnosed here.

How is pregnancy-associated Sweet’s syndrome treated?

  • Systemic steroids such as prednisone are the main form of treatment. Treatment should start with 1mg/kg/day or less, in a single dose taken in the morning, and should be tapered off until the minimum effective dose is determined (Serrano-Falcón and Serrano-Falcón, 2010:559).
  • Steroid creams can be used if the skin lesions are small and in one area, and if there are few other symptoms.
  • In 2018, the biologic, infliximab, was used to treat resistant Sweet’s syndrome in a 30-year-old pregnant woman with Crohn’s disease (Smolovic et al, 2018).

Are there treatments that should be avoided?

Yes, certain medications that are sometimes used to treat Sweet’s syndrome are not safe to use during pregnancy, e.g. potassium iodide.

Does Sweet’s syndrome cause complications or affect how you will be cared for during pregnancy?

Sweet’s syndrome doesn’t tend to cause complications during pregnancy or affect the baby. However, as a precaution, your doctor or nurse will need to monitor you as for an at-risk pregnancy.

Can pregnancy-associated Sweet’s syndrome come back once it has been treated?

Pregnancy-associated Sweet’s syndrome normally settles after treatment. This may take up to 7 days, weeks or months. Sometimes, the Sweet’s syndrome doesn’t completely settle until delivery of the baby, and may flare-up again with later pregnancies (Chebbi and Josephine, 2014).

Further information.

Giovanna Brunasso, A. and Massone, C. (2008) Clinical images. Sweet syndrome during pregnancy. CMAJ: Canadian Medical Association Journal, Oct 21;179(9):967 (PMC).

References.

Byrne, B., Schaler, L., DeMaio, A., Ryan, K., Regan, C. and Lynch, C. (2018) 420. A case report of Maternal Sweet’s syndrome: A rare complication of pregnancy. Pregnancy Hypertension, Oct, 13(Suppl 1):S150 (ScienceDirect).

Chebbi, W. and Josephine M. (2014) Sweet syndrome during pregnancy: a rare entity not to ignore. The Pan African Medical Journal, 18: 185 (PMC). Article in French. Use translate.

Serrano-Falcón, C. and Serrano-Falcón, M. (2010) Sweet’s syndrome in a pregnant women. Actas Dermo-Sifiliograficas, Jul;101(6):558-9 (online).

Smolovic, B., Gajic-Veljic, M., Nikolic, M. and  Muhovic, D. (2018) Pregnancy-Induced Sweet’s Syndrome Treated with Infliximab. Medical Principles and Practice: International Journal of the Kuwait University, Health Science Centre, Oct 30 (Karger). Click ‘PDF’ to access.

2012-present, Sweet’s Syndrome UK

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