137 Eosinophilic Cellulitis (Wells Syndrome): A Case Report. (11th January 2018)

• Record Type: Journal Article
• Authors: Abdulsattar, Jehan; AlZubaidi, Yasir; Cruz, Nestor Dela
• Is Part Of: American journal of clinical pathology. Volume 149(2018)Supplement 1
• Page Start: S59
• Page End: S59
• Publication Date: 2018-01-11
• Subjects: Diagnosis, Laboratory -- Periodicals; Pathology -- Periodicals; 616.07
• DOI: 10.1093/ajcp/aqx119.136
• Languages: English
• ISSNs: 0002-9173

Abstract

Abstract: Eosinophilic cellulitis (EC), also known as Wells syndrome, is a rare idiopathic, painful or pruritic, non-infectious type of cellulitis of unknown pathogenesis. EC usually presents as indurated plaques resembling infectious cellulitis, sometimes with blisters, usually resolving in several days or weeks, often with peripheral eosinophilia. Although most cases of EC are idiopathic, some are associated with arthropod bites, parasitic infection (such as giardiasis and toxocariasis), drug allergy, and internal malignancy. Here we report an unusual case of a 71-year-old man with a history of mantle cell lymphoma who presented with one-year history of pruritic furunculous skin lesion on the right elbow. Punch biopsy of the lesion showed an ulceration and dense inflammatory infiltrate that is composed predominately of eosinophils, neutrophils and lymphocytes. The infiltrate involves the entire dermis and extends to the subcutaneous tissue. The flame figures with degenerative collagen are also noted. A Periodic acid-Schiff (PAS) stain with adequate controls fails to reveal fungal hyphae. The histologic changes are consistent with Wells syndrome, which clinically resembles cellulitis, often with blister formation. This is a prime example of the value in performing the punch biopsy in this patient and educating the clinician about the pathogenesis of this type of skin lesion.