Histiocytoid Sweet syndrome is a recently described variant of acute febrile neutrophilic dermatosis. The histiocytoid cells are easily misinterpreted as histiocytes, when in fact they are immature myeloid cells. The recognition of myeloperoxidase expression in these cells is important in avoiding confusion with histiocyte-rich dermatoses. Herein, we report a case of histiocytoid Sweet syndrome with neutropenia that had an unusual presentation. The recognition of this rare combination helps expand the spectrum of Sweet syndrome with histiocytoid infiltrate.