Pulmonary signs did not improve on treatment with antifungal. A new chest-CT scan revealed increased alveolar infiltrates in the right upper lung with bilateral pleural effusion. A thoracocentesis was PLX4720 performed, consistent with a transudate. A second videobronchoscopy with BAL and transbronchial biopsies were performed. Cytological

study revealed a total cell count of 3.600 cell/ml, 72% neutrophils, 20% macrophages and 8% lymphocytes, new cultures were negative. Histopathological examination of the lung biopsy revealed extensive neutrophils infiltration with fibrin at the alveolar level, edema and focal acute and organizing pneumonia. (Fig. 3). This histological findings were similar to the one performed in the skin.

Antifungal therapy was stopped. The patient was treated with methylprednisolone (500 mg IV for 3 days) followed by oral prednisone. Steroid therapy produced a rapid improvement of cutaneous and pulmonary involvement. Patient had rapid clinical and radiographic resolution. After 2 weeks of therapy, erythematous plaques and skin lesions decreased. No recurrence was observed and chest CT scan showed a substantial improvement. The SS was described by Robert Douglas Sweet in 1964, typical manifestations are cutaneous lesion and clinical symptoms improve after treatment with systemic steroids. Extra cutaneous symptoms associated with SS are commons, occurs in ±40% of clinical presentations. selleck compound Fever, arthritis, musculoskeletal and ocular involvements such as conjunctivitis,

uveitis, episcleritis have been reported frequently in literature.1 and 2 Pulmonary involvement is very rare, in our review of 34 cases, the ratio man: female was 1:1, the age average is 57 years – old (±14 years old, range 25–82 years old). In 18 cases hematological disorders such as myelodisplastic syndrome, myeloproliferative disorder, agnogenic myeloid metaplasia, refractory anemia with excess blasts and idiopathic thrombocytopenia Progesterone were present. Eight cases of SS with pulmonary involvement were in previously healthy people.9, 10, 12, 14, 16, 17, 23 and 27 Summary of demographic, clinical, diagnosis, treatment and outcome of cases reported in literature are shown in Table 1.2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29 and 30 Skin involvement was the first manifestation in 16 of 34 cases. Typical symptoms are erythematous plaques and nodules, which may be recurrent and painful. Typical skin biopsy showed a dense infiltrate of neutrophils, primarily in dermis, associated to edema without vasculitis. In 12 of 34 cases, skins lesions and pulmonary involvements are simultaneous. If there is pulmonary involvement, it usually manifests with dry cough and dyspnea.11 Chest X-ray may reveal diffuse pulmonary infiltrated or pleural effusion, chest-CT usually confirms pulmonary involvement. Videobronchoscopy usually is normal.