Sweet Syndrome Imitating Cutaneous Cryptococcal Disease

Jordan, Ariel; Graciaa, Daniel S.; SN, Gopalsamy; SG, Neill; DC, Parker; LD, Aspey; JM, Collins

doi:10.1093/ofid/ofac608

Cited by 5 publications

(6 citation statements)

References 26 publications

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“…Table 1 outlines the clinical, laboratory, and histopathologic findings as well as the treatment course for these cases. [1][2][3][4][5][6][7][8][9] From this collated data, the average age of presentation was 71 years and there was a female predominance (75%). Clinical features were similar among cases and mirrored those associated with classic Sweet syndromenamely, the acute onset of tender, sharply demarcated, edematous, erythematous to violaceous papules, plaques, and nodules favoring the head, neck, and upper extremities.…”

Section: Discussionmentioning

confidence: 99%

“…Since this time, seven additional cases have been reported, plus this case for a total of 16 cases to date. Table 1 outlines the clinical, laboratory, and histopathologic findings as well as the treatment course for these cases 1–9 . From this collated data, the average age of presentation was 71 years and there was a female predominance (75%).…”

Section: Discussionmentioning

confidence: 99%

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Cryptococcoid Sweet syndrome: A case report and literature review

Stauder,

Topham,

Khouri

et al. 2024

Int J Dermatology

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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

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cryptococcoid Sweet syndrome: A case report and literature review

Stauder,

Topham,

Khouri

et al. 2024

Int J Dermatology

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“…A series of case reports showed that five out of eight patients with giant cellulitis-like SS were correlated with various malignancies such as myeloma, breast carcinoma, and acute myeloid leukemia (AML) [ 4 , 5 ]. A rare histologic variant of the crypto-coccoid Sweet syndrome can present with atypical hemorrhagic bullae and yeast-like structures imitating cutaneous cryptococcal disease [ 6 ]. The histological finding of a dense neutrophilic infiltrate without leukocytoclastic vasculitis supports the diagnosis of SS, therefore skin biopsy should be performed whenever feasible.…”

Section: Discussionmentioning

confidence: 99%

Giant Cellulitis-Like Sweet Syndrome Masquerading As Cellulitis and Shingles: A Case Report and Literature Review

Li¹,

Mian²,

Zaidi³

et al. 2023

Cureus

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Sweet syndrome (SS) is also known as acute febrile neutrophilic dermatoses. Clinically, SS features fever, arthralgias, and the sudden onset of an erythematous rash. The morphologies of skin lesions in SS are heterogenous, varying from papules, plaques, and nodules to hemorrhagic bullae, which sometimes makes the diagnosis of SS more challenging. We report a 62-year-old obese male with a history of chronic myeloid leukemia in remission for 10 years who presented with a rash for five days. The patient reported prodromal flu-like symptoms with subjective fever, malaise, cough, and nasal congestion followed by a sudden onset, painful, non-pruritic rash. The rash was associated with bilateral hip arthralgias and abdominal pain. The patient denied any recent travel, exposure to sick contacts, or the use of any new medications. Physical examination showed a well-demarcated, non-blanching, confluent, erythematous plaque involving the bilateral buttocks and extending to the lower back and flanks with coalescent "juicy"-appearing plaques and flaccid bullae. No oral or mucosal involvement was noted. Laboratory investigations revealed mild leukocytosis, elevated inflammatory markers, and acute kidney injury. The patient was started on antibiotics given the cellulitis-like skin lesions, leukocytosis with neutrophilia, and elevated inflammatory markers. Dermatology was consulted, who attributed the patient's rash to shingles and recommended initiating acyclovir and obtaining a skin biopsy. However, the patient's rash and arthralgias worsened with anti-viral treatment while awaiting pathology results. Antinuclear antibodies, complement, human immunodeficiency virus, hepatitis panel, blood cultures, and tumor markers were all negative. Flow cytometry showed no evidence of hematopoietic neoplasms. The skin punch biopsy revealed dense neutrophilic infiltration in the dermis with no evidence of leukocytoclastic vasculitis, consistent with acute neutrophilic dermatoses.The diagnosis of giant cellulitis-like Sweet syndrome was established, and the patient was started on prednisone 60 milligrams daily. His symptoms improved promptly with steroid treatment. Our case suggests that SS can camouflage a wide spectrum of diseases, including cellulitis, shingles, vasculitis, drug eruptions, leukemia cutis, and sarcoidosis, which emphasizes the importance of keeping a high index of suspicion for SS when assessing the clinical constellations of fever, neutrophilia, and erythematous plaques suggesting atypical cellulitis. Approximately 21% of Sweet syndrome is associated with malignancy. Sweet syndrome can precede, concur with, or follow the onset of malignancy. Due to the lack of a systematic approach to patients with SS, under-investigation and diagnostic delays are common. Therefore, further screening and continuous monitoring in patients with SS becomes especially important in facilitating the early detection of a potential underlying malignancy and assists in initiating adequate therapy.

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“…The lesions predominantly occur on the head, neck, and limbs, and have various clinical features, including acneiform papules, violaceous plaques, nodules, blisters, and ulcers . In addition to the clinical resemblance between Sweet syndrome and cutaneous cryptococcosis, the histologic findings of dermal infiltration of myeloperoxidase-positive myeloid cells with a surrounding halo, which are morphologically suggestive of cryptococcal organisms, have been described in cases of neutrophilic Sweet syndrome and HSS (cryptococcoid Sweet syndrome) . Cryptococcus in biopsy specimens can be identified as fungal elements surrounded by a bright area (a polysaccharide capsule) with hematoxylin-eosin staining.…”

Section: Discussionmentioning

confidence: 99%

“…9 In addition to the clinical resemblance between Sweet syndrome and cutaneous cryptococcosis, the histologic findings of dermal infiltration of myeloperoxidase-positive myeloid cells with a surrounding halo, which are morphologically suggestive of cryptococcal organisms, have been described in cases of neutrophilic Sweet syndrome and HSS (cryptococcoid Sweet syndrome). 10 Cryptococcus in biopsy specimens can be identified as fungal elements surrounded by a bright area (a polysaccharide capsule) with hematoxylin-eosin staining. Pathogens are stained by periodic acid-Schiff stain and Grocott methenamine silver stain, and their capsules are stained by mucicarmine.…”

Section: Discussionmentioning

confidence: 99%