Work

Necrotizing Sweet Syndrome as a Mimic of Necrotizing Soft Tissue Infection: A Narrative Review

Year: 2026

Type: review

Abstract: Necrotizing Sweet syndrome (NSS) is a rare and severe variant of Sweet syndrome characterized by erythematous and painful lesions accompanied by systemic inflammation. Because it closely mimics necrotizing soft tissue infections (NSTIs), NSS is frequently misdiagnosed, resulting in inappropriate treatment. This study reviewed published cases of NSS and characterized its demographic, clinical, and clinicopathologic features relevant to its differentiation from NSTI. For this narrative review, a literature search on PubMed (last updated June 30, 2024) identified 34 cases of NSS across 29 articles. Erythema was the most common feature (82.4%), followed by edematous plaques (41.2%). Necrosis (52.9%) and budllous lesions (38.2%), including hemorrhagic bullae, were also frequently observed, whereas pustular lesions were reported in 29.4% of cases. Multiple lesion morphologies often coexisted, highlighting the polymorphic presentation of NSS and its clinical overlap with NSTI. All patients underwent biopsy, 52.9% underwent surgical debridement, and 5.9% required amputation. Corticosteroids were the most frequently used treatment. NSS is a rare but important mimic of NSTI. Given its polymorphic presentation and overlapping cutaneous manifestations, including erythema, bullous change, and necrosis, differentiation cannot be based on clinical appearance alone and requires integration of microbiological and histopathological findings. Increased awareness of NSS is essential to avoid unnecessary surgical intervention and ensure timely, appropriate management.

Source: Clinical Cosmetic and Investigational Dermatology

DOI: 10.2147/ccid.s641833