Oral Sweet's syndrome occurring in ulcerative colitis.

A man aged 78 years presented with a 3-week history of tender mouth ulceration associated with arthralgia and weight loss. He had ulcerative colitis that was diagnosed 10 years previously which was well controlled on adalimumab 40 mg fortnightly. Biochemical and haematological investigations showed raised inflammatory markers (CRP 105) and a marked neutrophilia (10). On examination, the patient had severe oral ulceration involving the anterior tongue and lips. In addition, on cutaneous examination had tender erythematous nodules involving the forehead. Histology from a diagnostic punch biopsy showed marked dermal oedema with an inflammatory infiltrate consisting of neutrophils. Our working diagnosis was therefore oral Sweet's syndrome. The patient was then started on oral prednisolone and later received colchicine which led to a complete resolution of symptoms.

Trimester-specific reference intervals for haemoglobin A1c (HbA1c) in pregnancy.

BACKGROUND: Diabetes in pregnancy imposes additional risks to both mother and infant. These increased risks are considered to be primarily related to glycaemic control which is monitored by means of glycated haemoglobin (HbA(1c)). The correlation of HbA(1c) with clinical outcomes emphasises the need to measure HbA(1c) accurately, precisely and for correct interpretation, comparison to appropriately defined reference intervals. Since July 2010, the HbA(1c) assay in Irish laboratories is fully metrologically traceable to the IFCC standard. The objective was to establish trimester-specific reference intervals in pregnancy for IFCC standardised HbA(1c) in non-diabetic Caucasian women. METHODS: The authors recruited 311 non-diabetic Caucasian pregnant (n=246) and non-pregnant women (n=65). A selective screening based on risk factors for gestational diabetes was employed. All subjects had a random plasma glucose <7.7 mmol/L and normal haemoglobin level. Pregnancy trimester was defined as trimester 1 (T1, n=40) up to 12 weeks +6 days, trimester 2 (T2, n=106) 13-27 weeks +6 days, trimester 3 (T3, n=100) >28 weeks to term. RESULTS: The normal HbA(1c) reference interval for Caucasian non-pregnant women was 29-37 mmol/mol (Diabetes Control and Complications Trial; DCCT: 4.8%-5.5%), T1: 24-36 mmol/mol (DCCT: 4.3%-5.4%), T2: 25-35 mmol/mol (DCCT: 4.4%-5.4%) and T3: 28-39 mmol/mol (DCCT: 4.7%-5.7%). HbA(1c) was significantly decreased in trimesters 1 and 2 compared to non-pregnant women. CONCLUSIONS: HbA(1c) trimester-specific reference intervals are required to better inform the management of pregnancies complicated by diabetes.