Sweet Syndrome Imitating Cutaneous Cryptococcal Disease

Abstract

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 whereas staining for myeloperoxidase is positive. We present 2 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 histopathologic findings suggestive of Cryptococcus species.

Keywords: Cryptococcus; Sweet syndrome; mimics; neutrophilic dermatosis.

Figure 1.

Physical examination findings in case 1. Hemorrhagic vesicles and bullae on the legs (A), purpuric plaques on the chest (B) and hand (C), and hemorrhagic bullae on the hand (D).

Figure 2.

Skin biopsy specimen from case 1 at ×100 (A) and ×400 (B) magnification. Hematoxylin and eosin staining demonstrates a dense dermal infiltrate composed of neutrophilic inflammation, debris, and numerous rounded structures with some located in cleared-out spaces. These structures are seen singly, in apparent doublets, and some appear to display budding.

Figure 3.

Stains of skin biopsy specimen from case 1. Periodic-acid Schiff (A) and mucicarmine (B) staining did not demonstrate fungal organisms. Myeloperoxidase stain was positive, supporting the diagnosis of Sweet syndrome (C).

Figure 4.

Physical examination findings in case 2. Multiple edematous round plaques and nodules with central ulceration on the arm (A), chest (B), and leg (C).

Figure 5.

Skin biopsy specimen from case 2 at ×400 magnification. Hematoxylin and eosin staining demonstrates round forms in the dermis surrounded by vacuolated spaces.