Bullous hemorrhagic Sweet syndrome with cryptococcoid neutrophils in patients positive for antineutrophil cytoplasmic antibody without primary vasculitis

Sherban, Alex; Fuller, Collin; Sethi, Mansha; McGeehin, Eleni L; Hirokawa, Dawn; Guerrieri, Courtney; Lee, Jason B.; Yang, Sherry X.

doi:10.1016/j.jdcr.2020.10.006

Cited by 5 publications

(11 citation statements)

References 15 publications

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“…A case of bullous SS in a 10-year-old girl with a previous upper respiratory tract infection has also been described [37]. Two cases of bullous SS presenting with positive antineutrophil cytoplasmic antibodies (ANCA) without underlying vasculitis have also been described [38].…”

Section: Bullous Sweet Syndromementioning

confidence: 99%

New Practical Aspects of Sweet Syndrome

et al. 2022

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Sweet syndrome (SS), or acute febrile neutrophilic dermatosis, is an inflammatory, non-infectious skin reaction characterized clinically by tender, erythematous papules/plaques/pustules/nodules commonly appearing on the upper limbs, trunk, and head and neck; histologically, SS is characterized by dense neutrophilic infiltrate in the dermis. SS is accompanied by fever; an elevation of inflammatory markers (e.g., erythrocyte sedimentation rate, C reactive protein) in serum may also be observed. Although most cases of SS are idiopathic, SS also occurs in the setting of malignancy or following administration of an associated drug. SS has also been reported in association with pregnancy and a burgeoning list of infectious (most commonly upper respiratory tract infections) and inflammatory diseases; likewise, the litany of possible iatrogenic triggers has also grown. Over the past several years, a wider spectrum of SS presentation has been realized, with several reports highlighting novel clinical and histological variants. Corticosteroids continue to be efficacious first-line therapy for the majority of patients with SS, although novel steroid-sparing agents have been recently added to the therapeutic armamentarium against refractory SS. New mechanisms of SS induction have also been recognized, although the precise etiology of SS still remains elusive. Here, we catalogue the various clinical and histological presentations of SS, summarize recently reported disease associations and iatrogenic triggers, and review treatment options. We also attempt to frame the findings of this review in the context of established and emerging paradigms of SS pathogenesis.

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Section: Bullous Sweet Syndromementioning

confidence: 99%

New Practical Aspects of Sweet Syndrome

et al. 2022

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“…Another two cases of idiopathic SS with positive p‐ANCA, without stigmata of AAV, have also been reported 15 . The last three cases all had elevated p‐ANCA levels with either raised anti‐MPO (two cases) or anti‐PR3 titers (one case) 16 . While features of concomitant vasculitis were detected histopathologically, this was deemed secondary to SS and driven by concomitant sepsis 16 .…”

Section: Discussionmentioning

confidence: 93%

“…However, we do not believe our patient has CND from AAV because (1) she has no arthralgias, pulmonary involvement and mononeuritis multiplex and (2) her anti‐MPO/PR3 titers were undetectable. In the literature, 9 of 19 cases of CND also had positive ANCA serologies 9,12,13,15,16 . The first case is a patient who had CND because of idiopathic SS and a known history of AAV complicated by ESRF.…”

Section: Discussionmentioning

confidence: 99%

“…In the literature, 9 of 19 cases of CND also had positive ANCA serologies. 9,12,13,15,16 The first case is a patient who had CND because of idiopathic SS and a known history of AAV complicated by ESRF. His AAV was deemed to be in remission before presentation.…”

Section: Case Reportmentioning

confidence: 99%

“…15 The last three cases all had elevated p-ANCA levels with either raised anti-MPO (two cases) or anti-PR3 titers (one case). 16 While features of concomitant vasculitis were detected histopathologically, this was deemed secondary to SS and driven by concomitant sepsis. 16 In a retrospective study of 113 patients with detectable ANCA, 60.2% of cases did not have features of AAV, reiterating the lack of specificity of ANCA.…”

Section: Case Reportmentioning

confidence: 99%

See 2 more Smart Citations

Acute iododerma presenting as cryptococcoid neutrophilic dermatosis: A clinicopathological pitfall and interesting findings gleaned from a review of the literature

Liang

See

2022

J Cutan Pathol

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Iododerma is an uncommon dermatosis caused by excessive iodine exposure and is associated with significant morbidity and mortality. Because of its heterogenous clinical presentation and variable histopathological findings, which depend on the time the skin biopsy is performed, the diagnosis of iododerma is often delayed. We report a rare case of acute iododerma in a woman with end‐stage diabetic nephropathy with antecedent radioiodine contrast exposure, presenting histopathologically as cryptococcoid neutrophilic dermatosis (CND). We underscore important clinicopathological pitfalls to avoid misdiagnosis with similar overlapping entities such as Sweet syndrome, review all published cases of CND and draw novel insights into its associated entities.

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Sweet Syndrome Imitating Cutaneous Cryptococcal Disease

Jordan

Graciaa

et al. 2022

Open Forum Infectious Diseases

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Cryptococcoid Sweet syndrome is a rare histologic variant of the neutrophilic dermatosis presenting clinically with skin lesions typical of classical Sweet syndrome but with yeast-like structures suggestive of Cryptococcus on histopathology. Histochemical stains for fungus and cultures are negative while staining for myeloperoxidase is positive. We present two cases of cryptococcoid Sweet syndrome with atypical skin manifestations, including hemorrhagic bullae and plaques, and provide a brief review of the literature. Clinicians should be aware that this variant of Sweet syndrome can present with uncommon clinical findings and has histopathology findings suggestive of Cryptococcus species.

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Bullous hemorrhagic Sweet syndrome with cryptococcoid neutrophils in patients positive for antineutrophil cytoplasmic antibody without primary vasculitis

Cited by 5 publications

References 15 publications

New Practical Aspects of Sweet Syndrome

New Practical Aspects of Sweet Syndrome

Acute iododerma presenting as cryptococcoid neutrophilic dermatosis: A clinicopathological pitfall and interesting findings gleaned from a review of the literature

Sweet Syndrome Imitating Cutaneous Cryptococcal Disease

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