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Case Reports

Abstract

A 74-year-old female with a history of liposarcoma status-post resection with negative margins presented with a polymorphic skin eruption consisting of vegetative hypertrophic plaques and nodules on the ears, nose and lips, and necrotic plaques and hemorrhagic bullae affecting her hands and lower legs. She denied any systemic symptoms. The patient had taken trimethoprim-sulfamethoxazole and ciprofloxacin one week prior for presumed impetigo. Routine laboratory studies were non-contributory. The initial differential diagnosis was broad, and included disseminated fungal infection, thrombo-embolic disease, vasculitis, or connective tissue disease. Histopathology on the lesion involving the nose showed pseudoepitheliomatous hyperplasia with subjacent brisk mixed acute and chronic stromal inflammation and intraepithelial abscesses. Histopathology on the leg showed ulcerated epithelium with collections of neutrophils within the epithelium and subjacent stromal. Within the superficial dermis were vacuolated cells with clear cytoplasm and what resembled yeast form organisms resembling cryptococcus. Tissue culture, GMS and Fite stains, and serum serologies were negative for organisms. Pseudoepitheliomatous hyperplasia (also known as pseudocarcinomatous hyperplasia), mimicking squamous cell carcinoma, has rarely been reported in sweet syndrome (SS). Cryptococcoid SS is also a rare variant of SS that may clinically and histologically mimick cutaneous cryptococcus. The patient was discharged home with a diagnosis of SS and treated with topical medium-potency steroids with complete resolution of her findings. We present a rare case of concomittant cryptococcoid and pseudoepitheliomatous SS treated successfully with topical steroids.