Cryptococcoid Sweet Syndrome Following Gastrointestinal Neuroendocrine Tumor Removal: A Case Report

Sweet syndrome, an acute febrile neutrophilic dermatosis, is a reactive disorder that can occur in the setting of infection, malignancy, or medication exposure, although the exact etiology is unknown.Cryptococcoid Sweet syndrome is a rare variant that clinically aligns with Sweet syndrome yet has an initial histologic presentation indicative of a cryptococcal infection. This report describes an 81-year-old man presenting with multiple tender, sharply demarcated, erythematous to violaceous nodules on his forehead, cheeks, and fingers. This eruption occurred 24 hours after he underwent the surgical removal of a neuroendocrine tumor of the ileum. The histopathological examination of a skin biopsy of one of the nodules revealed a predominantly neutrophilic infiltrate present in the superficial dermis with dermal edema and pseudo-Cryptococcus-like structures. Periodic acid-Schiff (PAS) stain was negative for fungal organisms. These histologic findings, in light of the clinical presentation, led to a diagnosis of cryptococcoid Sweet syndrome. This report highlights the clinical and histopathological presentation of cryptococcoid Sweet syndrome, a morphologic mimicker of cutaneous cryptococcosis. Taking into consideration the rarity of cryptococcoid Sweet syndrome and the lack of an established relationship between this histologic presentation, malignancy, and surgery, we present this as an interesting case of cryptococcoid Sweet syndrome in the perioperative period of gastrointestinal neuroendocrine tumor manipulation.