Cryptococcoid Sweet syndrome: A case report and literature review

Abstract

tension, diabetes mellitus, former polysubstance use disorder (cocaine, LSD, and marijuana), and psoriasis was transferred from an outside hospital for acute on chronic renal failure, hypoxic respiratory failure, and progressive, painful rash. The patient's home medications included hydralazine, amlodipine, losartan, aspirin, carvedilol, finasteride, metoprolol, insulin, glimepiride, and tamsulosin. He first developed painful sores on his back 2 days prior to transfer, which rapidly spread to involve his face and lower extremities. He also endorsed arthralgias, ocular pain, diarrhea, and anuria. Examination revealed numerous erythematous to violaceous indurated papules and plaques with thick hemorrhagic crusting on the forehead and back and hemorrhagic bullae on the bilateral upper and lower extremitiesincluding peripheral IV sites (Figure 1).Oral ulceration and confluent hemorrhagic crusting of his lips were also noted.Two punch biopsies from lesions on his arm and leg demonstrated a dense neutrophilic dermal infiltrate, papillary edema, focal vasculitis, and vacuolar spaces with small basophilic nuclei (Figure 2). Immunohistochemical staining was diffusely positive for myeloperoxidase (MPO) and lysozyme. Direct immunofluorescence, HSV immunostaining, periodic acid Schiff (PAS), acid-fast bacillus (AFB), Grocott methenamine silver (GMS), and gram stains were all unremarkable. A broad infectious work-up was performed including screening for hepatitis B and C, viral PCRs (HSV, VZV, CMV and EBV), HIV, RPR, beta-D glucan, screening for endemic fungi (Cryptococcus, Coccidioidomycosis, and Blastomyces), Mycoplasma pneumoniae and Chlamydia pneumoniae, strongyloides serologies, extended respiratory viral panel, aerobic, anaerobic, and fungal cultures, tissue culture of skin biopsy and culture of