A Combination Regimen of Adalimumab and Methotrexate in a Challenging Case of Recalcitrant Gut and Cutaneous Sweet Syndrome

We report a case of a 50-year-old woman with cutaneous Sweet syndrome (SS) presenting with symptomatic iron deficiency anemia. Main clinical findings were cutaneous papules and small bowel ulcers, visualized on enteroscopy. She was eventually diagnosed with gut and cutaneous SS. After not responding to different treatment regimens, she was given subcutaneous adalimumab and oral methotrexate combination therapy, and finally achieved clinical remission. To our knowledge, this is the first reported case of such a treatment combination for recalcitrant gut and cutaneous SS. Although rare, a diagnosis of gut SS should be considered in similar clinical situations. In recalcitrant cases, anti–tumor necrosis factor-α agents may be considered.