Skip to main content

Table 9 Histologic differential diagnosis of Sweet's syndrome

From: Sweet's syndrome – a comprehensive review of an acute febrile neutrophilic dermatosis

Abscess/cellulitis Positive culture for infectious agent
Bowel (intestinal) bypass syndrome History of jejunal-ileal bypass surgery for morbid obesity
Erythema elevatum diutinum Erythematous asymptomatic plaques often located on the dorsal hands and elbows; younger lesions have microscopic features of leukocytoclastic vasculitis, whereas older lesions have dermal fibrosis and mucin
Granuloma faciale Yellow to red to brown indurated asymptomatic facial plaques; there is a grenz zone of normal papillary dermis beneath which there is a dense diffuse inflammatory infiltrate of predominantly neutrophils (with microscopic features of leukocytoclastic vasculitis) and frequently numerous eosinophils
Halogenoderma Neutrophilic dermal infiltrate with necrosis and pseudoepitheliomatous hyperplasia with intraepidermal abscesses; history of ingestion of bromides (leg lesions), iodides (facial lesions), or topical fluoride gel to teeth during tumor radiation therapy to face
Leukemia cutis Dermal infiltrate consists of immature neutrophils
Leukocytoclastic vasculitis Vessel wall destruction – extravasated erythrocytes, fibrinoid necrosis of vessel walls, karyorrhexis, and neutrophils in the vessel wall
Lobular neutrophilic panniculitides In addition to subcutaneous Sweet's syndrome, these include alpha 1-antitrypsin deficiency syndrome, factitial panniculitis (secondary to the presence of iatrogenic or self-induced foreign bodies), infectious panniculitis (secondary to either a bacterial, fungal, mycobacterial, or protozoan organism), pancreatic panniculitis, rheumatoid arthritis-associated panniculitis
Neutrophilic eccrine hidradenitis Neutrophils around eccrine glands, often in patients with acute myelogenous leukemia receiving induction chemotherapy
Pyoderma gangrenosum Painful ulcer with overhanging, undermined violaceous edges
Rheumatoid neutrophilic dermatitis History of rheumatoid arthritis, nodules, and plaques
Sweet's syndrome Acute onset, fever, neutrophilia, and painful plaques
  1. Source [346]: Adapted with permission from Cohen PR: Paraneoplastic dermatopathology: cutaneous paraneoplastic syndromes. Adv Dermatol 1995;11:215–252. Copyright 1995, Reprinted with permission from Elsevier Ltd, Oxford, United Kingdom.