ABSTRACT
Neutrophilic infiltrates of skin in the setting of lupus patients with bullous systemic lupus erythematosus (SLE) and leukocytoclastic vasculitis are well documented. However, most dermatology studies do not consider cutaneous involvement by SLE in the histologic differential diagnosis of neutrophilic inflammatory dermatosis in non-bullous or non-vasculitic lesions. Nevertheless, an increasing number of studies have reported cell-rich or Sweet's-like neutrophilic reactions as well as patients with skin lesions characterized by paucicellular neutrophilic dermal infiltrates. A 56-year-old female patient with history of lupus nephritis presented with multiple erythematous to brownish papulo-patches and plaques on both legs for 1 month. She had no signs or systemic symptoms of Sweet's syndrome. Histopathologic finding showed perivascular and interstitial neutrophilic infiltration with leukocytoclasia in the upper dermis, but not as dense as commonly observed in Sweet's syndrome with absence of papillary dermal edema. Herein, we present a rare case of non-bullous neutrophilic dermatosis associated with SLE. It is important to consider SLE-associated neutrophilic dermatosis in the differential diagnosis of neutrophilic tissue reactions and to be aware of the broad histologic spectrum that may be encountered in SLE-associated neutrophilic dermatosis, ranging from subtle paucicellular lesions to florid Sweet's-like lesions.
Subject(s)
Female , Humans , Middle Aged , Dermatology , Dermis , Diagnosis, Differential , Edema , Leg , Lupus Erythematosus, Systemic , Lupus Nephritis , Neutrophils , Skin , Skin Diseases , Sweet Syndrome , VasculitisABSTRACT
Cutaneous manifestation due to Cryptococcus neoformans is mostly reported in cases of the secondary findings to hematogenous dissemination while the primary cutaneous cryptococcosis (PCC) is a very rare. PCC usually occurs in immunocompromised hosts such as AIDS, hematopoietic malignancies, transplant recipients, and chronic corticosteroid users. Primary cryptococcosis and tuberculosis co-infection has been rarely reported in Korean literature. We report a case of PCC in a 22-year-old male with pulmonary tuberculosis, who had asymptomatic erythematous plaque and papules on the right cheek for 3 months. Histopathological examination showed numerous encapsulated round spores in the dermis and the organism was identified as Cryptococcus neoformans on fungal culture. The lesion was successfully treated with oral fluconazole for 6 months, and pulmonary tuberculosis was resolved after anti-tuberculosis therapy for 9 months.