Cryptococcus‐like changes in the setting of vasculitis

Abstract

Cutaneous vasculitis has many underlying causes, and the clinical and histological findings often overlap. Inflammatory vasculitis can mimic infection; however, distinction is critical for the timely institution of appropriate therapy. We present two patients who had generalized polymorphous eruptions whose cutaneous pathology showed vasculitis with unusual haloed yeast‐like cells within the inflammatory infiltrate, mimicking Cryptococcus. The unusual cells stained negatively with Gomori methenamine silver and periodic acid‐Schiff fungal stains, but positively for CD68 and had cytoplasmic reactivity with antibody to myeloperoxidase (MPO). Both patients had positive serum anti‐MPO antibodies. The first patient experienced a rapidly fatal course, whereas the second patient improved with prompt initiation of systemic corticosteroids. Interestingly, the second case had prior biopsy showing Sweet syndrome with crypotoccoid‐appearing cells. Cryptococcoid cells have been described previously in association with neutrophilic dermatoses, but not in the setting of vasculitis as was seen in our patients. Our cases add to the existing literature on crypotoccoid mimickers, and are the first to be reported in association with vasculitis.

Iodine toxicity after iodinated contrast: New observations in iododerma

“…Since then, there have been additional rare reports of cryptococcoid Sweet syndrome, 9,10 as well as cryptococcoid-like changes with vasculitis. 11 None of these reports mentioned iodine levels. In our cases, the presumed nuclear fragments within the haloed spaces stained with PU.1, suggesting that the structures were likely degenerating histiocytes.…”

Acute iododerma presenting as cryptococcoid neutrophilic dermatosis: A clinicopathological pitfall and interesting findings gleaned from a review of the literature

“…Up to now, 19 cases of CND have been reported and are summarized in Table 1. Various etiologies aside from iododerma, ranging from drug‐induced/idiopathic/leukemia‐related SS, levamisole‐induced ANCA vasculitis, and drug‐induced lupus erythematosus have been implicated 7–14 . Interestingly, at least 8 of 15 of the non‐iododerma cases had significant kidney impairment (National Kidney Foundation Kidney Disease Outcomes Quality Initiative Stage 3 and beyond), an important predisposing comorbidity for iododerma.…”

“…13 Another report revealed the postmortem detection of positive c-ANCA and anti-MPO antibodies (anti-PR3 had not been performed) in a case also labeled as CND from idiopathic SS. 9 The authors did not find features to deem their CND to be caused by AAV. Two other cases of elevated p-ANCA and anti-MPO titers were also encountered, but in the setting of levamisole-and hydralazineinduced CND from SS; both cases had findings of foci of LCV and these two drugs have been well-documented to have ANCA antibodies involved in their pathogenesis.…”

“…Various etiologies aside from iododerma, ranging from drug-induced/idiopathic/leukemia-related SS, levamisoleinduced ANCA vasculitis, and drug-induced lupus erythematosus have been implicated. [7][8][9][10][11][12][13][14] Interestingly, at least 8 of 15 of the noniododerma cases had significant kidney impairment (National Kidney Foundation Kidney Disease Outcomes Quality Initiative Stage 3 and beyond), an important predisposing comorbidity for iododerma. Specific data on the renal function at time of cutaneous eruption in the other seven cases were not furnished.…”

A hydralazine-induced triumvirate: Lupus, cutaneous vasculitis, and cryptococcoid Sweet syndrome

“…Sweet syndrome is a reactive phenomenon that can occur in the setting of infection, underlying malignancy, or medications. The presence of inflammatory debris mimicking Cryptococcus has been reported in the setting of both neutrophilic dermatoses (termed cryptococcoid Sweet 5 ) and vasculitis 1 , 6 . These unusual vacuolated spaces are thought to represent ballooning degeneration of neutrophils 6 …”