Necrotizing Sweet Syndrome as a Mimic of Necrotizing Soft Tissue Infection: A Narrative Review.
12 affiliations
- 1Clinical Training Center, Southern TOHOKU General Hospital, Fukushima, Japan.
- 2Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan.
- 3Division of General Medicine, Nerima Hikarigaoka Hospital, Tokyo, Japan.
- 4Clinical Training Center, Juntendo University Hospital, Tokyo, Japan.
- 5Clinical Training Center, Tokyo Yamate Medical Center, Tokyo, Japan.
- 6Medical School, Okayama University School of Medicine, Okayama, Japan.
- 7Clinical Training Center, Nihon University Itabashi Hospital, Tokyo, Japan.
- 8Hongo-Ochanomizu Campus Academic Media Center, Juntendo University, Tokyo, Japan.
- 9Asia University Library, Asia University, Tokyo, Japan.
- 10Department of Dermatology and Allergology, Juntendo University Graduate School of Medicine, Tokyo, Japan.
- 11Division of Medical Education, Juntendo University School of Medicine, Tokyo, Japan.
- 12Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Tochigi, Japan.
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.
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BibTeX
@article{fujita2026necrotizing,
title = {{Necrotizing Sweet Syndrome as a Mimic of Necrotizing Soft Tissue Infection: A Narrative Review.}},
author = {Daiki Fujita and Taiju Miyagami and Taku Harada and Yoshiki Tsumura and Ryo Hisatomi and Hikari Saito and Ryusuke Otabe and Naoko Mizushima and Yasuhiko Kiyama and Yuka Konishi and Akinori Matsuda and Yuji Nishizaki and Taro Shimizu},
journal = {Clinical, cosmetic and investigational dermatology},
year = {2026},
month = oct,
doi = {10.2147/ccid.s641833},
url = {https://europepmc.org/article/MED/42968928},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Necrotizing Sweet Syndrome as a Mimic of Necrotizing Soft Tissue Infection: A Narrative Review.
AU - Daiki Fujita
AU - Taiju Miyagami
AU - Taku Harada
AU - Yoshiki Tsumura
AU - Ryo Hisatomi
AU - Hikari Saito
AU - Ryusuke Otabe
AU - Naoko Mizushima
AU - Yasuhiko Kiyama
AU - Yuka Konishi
AU - Akinori Matsuda
AU - Yuji Nishizaki
AU - Taro Shimizu
PY - 2026
DA - 2026/10/28
JO - Clinical, cosmetic and investigational dermatology
DO - 10.2147/ccid.s641833
UR - https://europepmc.org/article/MED/42968928
AB - 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.
SN - 1178-7015
ER -