PMC5664242_01
Skin findings. (a) Edematous papules and plaques of acute lesions of Sweet's Syndrome. (b) Well-established lesions of Sweet's Syndrome consisting of annual papules and plaques with scale and crust. (c) Finger changes seen in our patient with subungual inflammation splinter hemorrhages and inflammation and scaling of several fingertips.
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fig1
Three weeks earlier, bilateral knee, elbow, wrist, and hand pain with multiple erythematous papules and plaques on his neck, forehead, and forearms abruptly developed without response to naproxen (Figure 1). Painful erythema and edema of the fingertips with splinter hemorrhages of the nails appeared at two weeks (Figure 1).
PMC5664242_02
Biopsy findings. (a) Histological section showing fairly prominent papillary dermal edema and a somewhat dense dermal infiltrate comprised of mixed inflammatory cells (hematoxylin-eosin, original magnification: x40). (b) Many large histiocytic cells are present as well as lymphocytes and scattered neutrophils (hematoxylin-eosin, original magnification: x400). Leukocytoclastic debris is noted, but evidence of vasculitis is lacking. (c) Myeloperoxidase immunohistochemical stain reveals scattered neutrophils but is negative in the histiocytic cells (original magnification: x200). (d) Histiocytic cells are confirmed to be histiocytes and not mononuclear myelocytes (CD163 immunohistochemical stain, original magnification: x100). (e) Background T lymphocytes (CD3 immunohistochemical stain, original magnification: x100).
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fig2
Analysis of the skin biopsy from a 22-day-old lesion is shown in Figure 2.