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Praturlon I, Sant L, D'Alì L, Andrade S, Errichetti E, Cogo P, Martini G. Recurrent eosinophilic cellulitis (Wells syndrome) after vaccination in a child. J Dermatol 2024. [PMID: 39301950 DOI: 10.1111/1346-8138.17417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/13/2024] [Accepted: 07/22/2024] [Indexed: 09/22/2024]
Affiliation(s)
- Ilaria Praturlon
- Pediatric Division, Department of Medicine, Academic Hospital S Maria della Misericordia, Udine, Italy
| | - Lisa Sant
- Pediatric Division, Department of Medicine, Academic Hospital S Maria della Misericordia, Udine, Italy
| | - Lorenzo D'Alì
- Institute of Pathology, Academic Hospital S. Maria della Misericordia, Udine, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Stefanny Andrade
- Pediatric Division, Department of Medicine, Academic Hospital S Maria della Misericordia, Udine, Italy
| | - Enzo Errichetti
- Department of Medicine, University of Udine, Udine, Italy
- Institute of Dermatology, Academic Hospital S. Maria della Misericordia, Udine, Udine, Italy
| | - Paola Cogo
- Pediatric Division, Department of Medicine, Academic Hospital S Maria della Misericordia, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Giorgia Martini
- Pediatric Division, Department of Medicine, Academic Hospital S Maria della Misericordia, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
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2
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Michelerio A, Rubatto M, Roccuzzo G, Coscia M, Quaglino P, Tomasini C. Eosinophilic Dermatosis of Hematologic Malignancy: Emerging Evidence for the Role of Insect Bites-A Retrospective Clinico-Pathological Study of 35 Cases. J Clin Med 2024; 13:2935. [PMID: 38792476 PMCID: PMC11121821 DOI: 10.3390/jcm13102935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objectives: Eosinophilic dermatosis of hematologic malignancy (EDHM) is a rare cutaneous disorder associated with various hematologic malignancies, most commonly chronic lymphocytic leukemia. Detailed clinicopathologic studies of EDHM are lacking and the pathogenesis remains enigmatic. Initially thought to be a hypersensitivity reaction to insect stings, subsequent reports have challenged this understanding. The prognostic implications of EDHM remain unclear. Methods: A retrospective clinicopathologic study was performed on patients diagnosed with EDHM. Hematologic and dermatologic data were reviewed. Histologic specimens were re-evaluated and lesions were classified into acute/subacute, fully developed, and chronic/regressing. Results: The study included 35 patients. In 80% of these patients, EDHM was diagnosed after the hematologic disorder. Approximately 45% of the cohort experienced hematologic disease progression or relapse, while 65% required therapeutic intervention during the course of their hematologic disease. In total, 15/19 CLL patients had non-mutated IgHV, a marker of a more aggressive hematologic disease course. Dermatologic lesion morphology was heterogeneous, with most lesions occurring on exposed areas, and a significant 94% of patients demonstrated lesion seasonality. Histopathologic findings were consistent with features typically associated with insect bites. In addition, examination of lesions at different chronological stages revealed substantial similarities with Wells syndrome. Conclusions: Our findings support the potential role of insect bites in triggering EDHM in the context of adaptive immune dysfunction. EDHM may be associated with a more aggressive disease course or may be a marker of disease progression. The observed co-occurrence of features typical of Wells syndrome in EDHM patients suggests that these conditions are part of a spectrum of disorders that vary in clinical expression.
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Affiliation(s)
- Andrea Michelerio
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
- Dermatology Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Marco Rubatto
- Department of Medical Sciences, Section of Dermatology, University of Turin, 10126 Turin, Italy
| | - Gabriele Roccuzzo
- Department of Medical Sciences, Section of Dermatology, University of Turin, 10126 Turin, Italy
| | - Marta Coscia
- Department of Molecular Biotechnology and Health Sciences, University of Turin, 10126 Turin, Italy
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Pietro Quaglino
- Department of Medical Sciences, Section of Dermatology, University of Turin, 10126 Turin, Italy
| | - Carlo Tomasini
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
- Dermatology Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
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3
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Maronese CA, Derlino F, Moltrasio C, Cattaneo D, Iurlo A, Marzano AV. Neutrophilic and eosinophilic dermatoses associated with hematological malignancy. Front Med (Lausanne) 2024; 10:1324258. [PMID: 38249974 PMCID: PMC10796805 DOI: 10.3389/fmed.2023.1324258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Cutaneous manifestations of hematologic malignancy represent both a clinical challenge for the treating physician and a pathophysiological model for advancing the knowledge on individual neoplasms. Indeed, a growing body of evidence supports the concept of recurrent molecular defects associating with specific clinical features, as best exemplified by VEXAS. Herein neutrophilic and eosinophilic dermatoses of potential interest for both hematologists and dermatologists will be reviewed, including subcorneal pustular dermatosis-type IgA pemphigus, neutrophilic eccrine hidradenitis, Sweet's syndrome as well as myelodysplasia cutis and VEXAS, pyoderma gangrenosum, eosinophilic annular erythema, eosinophilic dermatosis of hematological malignancy, Wells syndrome and cutaneous involvement in hypereosinophilic syndromes. Possible management approaches are discussed for each, emphasizing scenarios that require treatment of the underlying condition to achieve remission at the skin level.
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Affiliation(s)
- Carlo Alberto Maronese
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Federica Derlino
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniele Cattaneo
- Hematology Division, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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4
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Deniz M, Demir-Önder K, Özkaraman Y, Adıgüzel Z, Balaban K. Clinical Entity Mimicking Infectious Cellulitis: Eosinophilic Cellulitis (Wells' Syndrome). INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2023; 5:376-379. [PMID: 38633856 PMCID: PMC10986720 DOI: 10.36519/idcm.2023.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/28/2023] [Indexed: 04/19/2024]
Abstract
Eosinophilic cellulitis (EC) is a skin disease characterized by pruritic, non-purulent, erythematous plaques and histologically by edema and eosinophil infiltration in the dermis. The etiopathogenesis of the disease is not fully elucidated. It differs from infectious cellulitis by being unresponsive to antibiotics and recurring. This case report presents a late-diagnosed case of EC in a patient who did not respond to long-term and broad-spectrum antibiotics. This case underscores the importance of skin biopsy and histopathological diagnosis in patients with recurrent, non-responsive, antibiotic-resistant, and cellulitis-like clinical features resembling infectious cellulitis; "eosinophilic cellulitis" should be considered in the differential diagnosis.
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Affiliation(s)
- Mustafa Deniz
- Department of Infectious Diseases and Clinical Microbiology, Health Sciences University Antalya Training and Research Hospital, Antalya, Türkiye
| | - Kübra Demir-Önder
- Department of Infectious Diseases and Clinical Microbiology, Health Sciences University Antalya Training and Research Hospital, Antalya, Türkiye
| | - Yusuf Özkaraman
- Department of Infectious Diseases and Clinical Microbiology, Health Sciences University Antalya Training and Research Hospital, Antalya, Türkiye
| | - Zafer Adıgüzel
- Department of Infectious Diseases and Clinical Microbiology, Health Sciences University Antalya Training and Research Hospital, Antalya, Türkiye
| | - Kadir Balaban
- Department of Pathology, Health Sciences University Antalya Training and Research Hospital, Antalya, Türkiye
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5
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Shimshak S, Wentworth A, Sokumbi O. Edematous Plaque on the Elbow of an Infant. J Pediatr 2023; 262:113661. [PMID: 37543282 DOI: 10.1016/j.jpeds.2023.113661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/07/2023]
Affiliation(s)
| | - Ashley Wentworth
- Department of Dermatology, Mayo Clinic Florida, Jacksonville, Florida
| | - Olayemi Sokumbi
- Department of Dermatology, Mayo Clinic Florida, Jacksonville, Florida; Department of Laboratory Medicine & Pathology, Mayo Clinic Florida, Jacksonville, Florida
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6
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Bocchi C, Marzola E, Pedriali M, Borghi A, Corazza M. Wells' Syndrome associated with COVID-19 vaccination. Ital J Dermatol Venerol 2023; 158:374-375. [PMID: 37539510 DOI: 10.23736/s2784-8671.23.07591-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Affiliation(s)
- Chiara Bocchi
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy -
| | - Elisa Marzola
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Massimo Pedriali
- Section of Anatomopathology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Alessandro Borghi
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Monica Corazza
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
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7
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Manti M, Pappa E, Arkouli V, Marinos L, Christopoulos C. Wells Syndrome with Generalized Oedema. Eur J Case Rep Intern Med 2023; 10:003954. [PMID: 37455694 PMCID: PMC10348442 DOI: 10.12890/2023_003954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 05/31/2023] [Indexed: 07/18/2023] Open
Abstract
Wells syndrome or eosinophilic cellulitis is a rare and relapsing skin disease which lacks systemic involvement. A skin biopsy is needed to establish a diagnosis. Several precipitating factors have been proposed but no proven causative link has been found. On the other hand, Churg-Strauss syndrome, also known as eosinophilic granulomatosis with polyangiitis (EGPA), an auto-immune disease, is associated with multiorgan, including cutaneous manifestations. We report a case with overlapping features of Wells and Churg-Strauss syndrome, suggesting that these syndromes could be part of the same nosological entity. LEARNING POINTS Biopsies are essential to establish a diagnosis in unusual cases of cellulitis.COVID-19 vaccination is a putative trigger for Wells syndrome.There is significant overlap between Wells and Churg-Strauss syndromes.
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Affiliation(s)
- Magdalini Manti
- First Internal Medicine Department, “Sismanoglio” General Hospital, Athens, Greece
| | - Efthymia Pappa
- First Internal Medicine Department, “Sismanoglio” General Hospital, Athens, Greece
| | - Vasiliki Arkouli
- First Internal Medicine Department, “Sismanoglio” General Hospital, Athens, Greece
| | - Leonidas Marinos
- Department of Hematopathology “Evangelismos” General Hospital, Athens, Greece
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8
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McMullan P, Torre K, Santiago S, Weston G, Lu J. Atypical Wells syndrome successfully treated with dupilumab. SKIN HEALTH AND DISEASE 2023; 3:e206. [PMID: 37275406 PMCID: PMC10233161 DOI: 10.1002/ski2.206] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/29/2022] [Accepted: 12/22/2022] [Indexed: 03/11/2024]
Abstract
Wells syndrome, also referred to as eosinophilic cellulitis, is a rare and often sporadic inflammatory skin condition whose aetiology remains uncertain. Clinically, this condition presents as a collection of erythematous, oedematous, and tender skin lesions most often affecting the extremities and trunk that can mimic cellulitis. Histologically, Wells syndrome is characterised by inflammatory changes and eosinophilic infiltration of the dermis with the absence of underlying infection, thereby distinguishing it from cellulitis. Due to the rarity of this syndrome and its ambiguous presentation, there remains to be a definitive strategy for treatment. Recent case reports have documented varying success and recurrence with the use of oral and topical corticosteroids, antifungals, antibiotics, immunosuppressants and antihistamines. Here, we report a unique case of progressively worsening neutrophilic-rich Wells syndrome on the vertex of the scalp that was successfully treated with a combination of dupilumab and oral corticosteroids.
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Affiliation(s)
- Patrick McMullan
- Department of DermatologyUniversity of Connecticut Health CenterFarmingtonConnecticutUSA
| | - Kristin Torre
- Department of DermatologyUniversity of Connecticut Health CenterFarmingtonConnecticutUSA
| | - Sueheidi Santiago
- Department of DermatologyUniversity of Connecticut Health CenterFarmingtonConnecticutUSA
| | - Gillian Weston
- Department of DermatologyUniversity of Connecticut Health CenterFarmingtonConnecticutUSA
| | - Jun Lu
- Department of DermatologyUniversity of Connecticut Health CenterFarmingtonConnecticutUSA
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9
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Kim Y, Bae KN, Son JH, Shin K, Kim H, Ko HC, Kim B, Kim MB. Bullous Wells Syndrome Induced by Ustekinumab. Ann Dermatol 2023; 35:S180-S181. [PMID: 37853906 PMCID: PMC10608391 DOI: 10.5021/ad.21.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/16/2021] [Indexed: 10/20/2023] Open
Affiliation(s)
- Yeona Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
- Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Kyung-Nam Bae
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
| | - Jin-Hwa Son
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
| | - Kihyuk Shin
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
- Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hoonsoo Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
- Department of Dermatology, Pusan National University Hospital, Busan, Korea
| | - Hyun-Chang Ko
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
- Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Byungsoo Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
- Department of Dermatology, Pusan National University Hospital, Busan, Korea
| | - Moon-Bum Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
- Department of Dermatology, Pusan National University Hospital, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
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10
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Vongsachang H, Bleicher ID, Reshef ER, Stagner AM, Wolkow N. Wells Syndrome Presenting as Atypical Periorbital Cellulitis. Ophthalmic Plast Reconstr Surg 2022; 38:e167-e170. [PMID: 35699219 DOI: 10.1097/iop.0000000000002220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 62-year-old man presented with diffuse, painless, left-sided preseptal edema, erythema, and woody induration extending to the left temple. The induration generated an orbital compartment syndrome with markedly elevated intraocular pressure necessitating lateral canthotomy and cantholysis. Although atypical for an infectious etiology, empiric broad-spectrum intravenous antibiotics were initiated with no improvement. A tissue biopsy demonstrated extensive perivascular and interstitial eosinophils with focal flame figures, and the patient was diagnosed with a severe hypersensitivity reaction or eosinophilic cellulitis (Wells syndrome). The disease process remitted rapidly upon initiation of oral prednisone. Wells syndrome is a rare inflammatory eosinophilic dermatosis, most often presenting in the limbs and trunk, with few reports of facial and periorbital involvement. This case highlights the importance of considering Wells syndrome in the differential diagnosis of atypical periorbital cellulitis that is nonresponsive to antibiotics and reviews the clinicopathologic nature of this disease.
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Affiliation(s)
| | - Isaac D Bleicher
- Department of Ophthalmology, Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Edith R Reshef
- Department of Ophthalmology, Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Anna M Stagner
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Natalie Wolkow
- Department of Ophthalmology, Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
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11
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Moseley I, Yang EJ, Mathieu RJ, Elco C, Massoud CM. Wells’ syndrome as a presenting sign of COVID-19 in the setting of allergic rhinitis and iron deficiency anemia. JAAD Case Rep 2022; 23:27-30. [PMID: 35261918 PMCID: PMC8890785 DOI: 10.1016/j.jdcr.2022.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Isabelle Moseley
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Correspondence to: Isabelle Moseley, AB, 555 South Water Street Apt 319 Providence, RI 02903.
| | - Eric J. Yang
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Regine J. Mathieu
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Christopher Elco
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Pathology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Cathy M. Massoud
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Pathology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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12
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de Montjoye L, Marot L, Baeck M. Eosinophilic cellulitis after BNT162b2 mRNA Covid-19 vaccine. J Eur Acad Dermatol Venereol 2021; 36:e26-e28. [PMID: 34547138 DOI: 10.1111/jdv.17685] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/16/2021] [Indexed: 12/16/2022]
Affiliation(s)
- L de Montjoye
- Department of Dermatology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - L Marot
- Department of Dermatology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium.,Department of Anatomopathology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - M Baeck
- Department of Dermatology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium
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13
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Papaetis GS, Politou VN, Panagiotou SM, Georghiou AA, Antonakas PD. Recurrent Cellulitis-Like Episodes of the Lower Limbs and Acute Diarrhea in a 30-Year-Old Woman: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e932732. [PMID: 34464376 PMCID: PMC8420709 DOI: 10.12659/ajcr.932732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Patient: Female, 30-year-old
Final Diagnosis: Wells syndrome
Symptoms: Acute diarrhea • chronic recurrent episodes resembling cellulitis to her lower limbs bs
Medication: —
Clinical Procedure: Skin biopsy
Specialty: Dermatology • Family Medicine
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Affiliation(s)
- George S Papaetis
- Internal Medicine and Diabetes Clinic, Paphos, Cyprus.,CDA College, Paphos, Cyprus
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14
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Iinuma S, Takahashi C, Ishida-Yamamoto A. Eosinophilic cellulitis with pustular lesions. Int J Dermatol 2021; 61:e227-e228. [PMID: 34242415 DOI: 10.1111/ijd.15785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/02/2021] [Accepted: 06/17/2021] [Indexed: 02/03/2023]
Affiliation(s)
- Shin Iinuma
- Department of Dermatology, Japanese Red Cross Kitami Hospital, Kitami, Japan
| | - Chiaki Takahashi
- Department of Dermatology, Japanese Red Cross Kitami Hospital, Kitami, Japan
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15
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Yeon J, Chan RCF, Zagarella S. Eosinophilic cellulitis successfully treated with Methotrexate. Australas J Dermatol 2020; 61:e421-e423. [DOI: 10.1111/ajd.13358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 05/04/2020] [Accepted: 05/09/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Janice Yeon
- Concord Repatriation General Hospital Concord NSW Australia
| | - Renee CF Chan
- Concord Repatriation General Hospital Concord NSW Australia
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16
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Mejbel HA, Preiszner J, Shurbaji MS, Leicht SS, Youngberg GA. Luna stain: a simple and cost-effective diagnostic tool helps in detecting eosinophilic granules deposition of flame figures and aids in diagnosing eosinophilic cellulitis "Wells Syndrome". J Histotechnol 2020; 43:196-199. [PMID: 33245262 DOI: 10.1080/01478885.2020.1818456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We report a rare case of Wells syndrome in which a 61-year-old Caucasian male presented with three distinct skin lesions including a cutaneous bulla, an erythematous plaque, and a linear streak located on the patient's left anterior thigh, left dorsal wrist, and left anterior forearm, respectively. Histologic examination revealed diffuse and interstitial eosinophilic infiltrate admixed with lymphocytes and macrophages that predominantly involve the dermis. Nodular aggregates of eosinophils surrounding dermal collagen fibers suggestive of 'flame figures' were identified. Luna histochemical stain was used and highlighted the deposition of eosinophilic granules over the collagen bundles confirming the presence of flame figures. Laboratory workup revealed peripheral eosinophilia, but a comprehensive clinical evaluation failed to reveal a systemic disease and ultimately the diagnosis of eosinophilic cellulitis 'Wells Syndrome' was rendered. After a short course of immunosuppressive therapy, the patient experienced a complete resolution of the skin lesions on his last follow-up visit several weeks from the initial diagnosis. This case highlights the various clinical forms that Wells syndrome may present with and may serve as a good example for the use of Luna stain as a simple and cost-effective diagnostic tool that can help to arrive at the accurate diagnosis and inform therapy.
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Affiliation(s)
- Haider A Mejbel
- Department of Pathology, East Tennessee State University Quillen College of Medicine , Johnson City, TN, USA.,Current Affiliation: Department of Pathology, The University of Alabama at Birmingham , Birmingham, AL, USA
| | - Johanna Preiszner
- Department of Pathology, East Tennessee State University Quillen College of Medicine , Johnson City, TN, USA
| | - M Salah Shurbaji
- Department of Pathology, East Tennessee State University Quillen College of Medicine , Johnson City, TN, USA
| | - Stuart S Leicht
- Department of Dermatology, East Tennessee State University Quillen College of Medicine , Johnson City, TN, USA
| | - George A Youngberg
- Department of Pathology, East Tennessee State University Quillen College of Medicine , Johnson City, TN, USA
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Alves P, Foale R, Cerundolo R, Valls Sànchez F. Canine acute eosinophilic dermatitis with oedema (Wells‐like syndrome) associated with T‐cell multicentric lymphoma. VETERINARY RECORD CASE REPORTS 2020. [DOI: 10.1136/vetreccr-2020-001136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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18
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Kettani F, Baline K, Hali F, Azzouzi S, Chiheb S. [Wells syndrome misdiagnosed as bacterial cellulitis]. Rev Med Interne 2020; 41:496-499. [PMID: 32089327 DOI: 10.1016/j.revmed.2020.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 01/23/2020] [Accepted: 02/02/2020] [Indexed: 10/25/2022]
Abstract
Wells syndrome (WS), also called eosinophilic cellulitis is a rare inflammatory skin disease with about 200 cases reports in the literature. It is part of eosinophilic dermatoses and presents a diagnostic challenge. We report a case of WS presenting as bacterial cellulitis. A 59 year-old woman was referred to our department with a 10-day history of a rapidly extending erysipelatoid rash of the left upper limb, non-responding to oral antibiotics. Upon physical examination, erythema with swelling and blisters were found on the left upper limb with urticarial-like lesions on the breast, the belly and on the inner thighs. The patient was admitted with presumed bacterial cellulitis and was treated with intravenous ampicillin. Blood count showed raised eosinophils (2050/ul) along with a biological inflammatory syndrome. Biopsies were performed on both bullous and urticarial-like lesions showing perivascular and interstitial inflammatory infiltrate, made essentially of eosinophils with flame figures. The diagnosis of WS was made and the patient received local and oral corticosteroids (0,5mg/kg/d) with good evolution. The rarity and clinical manifestations of WS makes it sometimes difficult to differentiate between a WS and a bacterial cellulitis. However, biological and histological findings can help the clinician make the differential diagnosis between these two diseases for a better management.
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Affiliation(s)
- F Kettani
- Service de dermatologie et vénéréologie, CHU de Ibn Rochd, Casablanca, Maroc.
| | - K Baline
- Service de dermatologie et vénéréologie, CHU de Ibn Rochd, Casablanca, Maroc
| | - F Hali
- Service de dermatologie et vénéréologie, CHU de Ibn Rochd, Casablanca, Maroc
| | - S Azzouzi
- Laboratoire d'anatomie pathologique Oum-Rabii, Casablanca, Maroc
| | - S Chiheb
- Service de dermatologie et vénéréologie, CHU de Ibn Rochd, Casablanca, Maroc
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Fournier C, Auger I, Houle MC. Wells syndrome (eosinophilic cellulitis) following vaccination: Two pediatric cases with positive patch test to aluminium salts. Contact Dermatitis 2020; 82:401-402. [PMID: 32034766 DOI: 10.1111/cod.13485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 02/01/2023]
Affiliation(s)
- Cynthia Fournier
- Division of dermatology, CHU de Québec, Laval University, Québec, Canada
| | - Isabelle Auger
- Division of dermatology, CHU de Québec, Laval University, Québec, Canada
| | - Marie-Claude Houle
- Division of dermatology, CHU de Québec, Laval University, Québec, Canada
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Ito T, Yamamoto T. Wells syndrome after radiation therapy. J Dermatol 2020; 47:e75-e77. [PMID: 31960465 DOI: 10.1111/1346-8138.15217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Takashi Ito
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - Toshiyuki Yamamoto
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
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21
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Peckruhn M, Elsner P, Tittelbach J. Eosinophile Hautkrankheiten. J Dtsch Dermatol Ges 2019; 17:1039-1052. [DOI: 10.1111/ddg.13943_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/19/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Melanie Peckruhn
- Klinik für Hautkrankheiten, Universitätsklinikum Jena, Erklärung zu nichtfinanziellen Interesse: Organisation: Universitätsklinikum Jena Position in dieser Organisation: Fachärztin Mitgliedschaft und Position in wissenschaftlichen Gesellschaften/Berufsverbänden/Vereinigungen: keine
| | - Peter Elsner
- Klinik für Hautkrankheiten, Universitätsklinikum Jena, Erklärung zu nichtfinanziellen Interesse: Organisation: Universitätsklinikum Jena Position in dieser Organisation: Kliniksdirektor Mitgliedschaft und Position in wissenschaftlichen Gesellschaften/Berufsverbänden/Vereinigungen: Mitglied des Vorstands des BVDD, DDG Präsidium. Mitglied des Vorstands der DDG
| | - Jörg Tittelbach
- Klinik für Hautkrankheiten, Universitätsklinikum Jena Erklärung zu nichtfinanziellen Interesse: Organisation: Universitätsklinikum Jena Position in dieser Organisation: Oberarzt und stellv. Kliniksdirektor Mitgliedschaft und Position in wissenschaftlichen Gesellschaften/Berufsverbänden/Vereinigungen: Mitglied DDG
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Heinig B, Vojvocic A, Lotti T, Tirant M, Wollina U. Wells Syndrome - An Odyssey. Open Access Maced J Med Sci 2019; 7:3002-3005. [PMID: 31850109 PMCID: PMC6910816 DOI: 10.3889/oamjms.2019.572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/22/2019] [Accepted: 06/23/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Wells syndrome is a rare idiopathic dermatosis of the eosinophilic spectrum. Diagnostic criteria include cutaneous eruptions of variable morphology with eosinophilic infiltrates, peripheral blood eosinophilia, a relapsing, remitting course, and exclusion of systemic disease. Diagnosis is often delayed. CASE PRESENTATION We present a 28-year older man with recently developed pruritic and sometimes painful erythema. His medical history was positive for coughing in the evening that started in November 2012. Later, a pansinusitis developed. Early diagnosis improves the outcome. CONCLUSION Standardized treatment has yet to be developed. In our case, systemic corticosteroids were of limited value only.
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Affiliation(s)
- Birgit Heinig
- Center of Physical and Rehabilitative Medicine, Städtisches Klinikum Dresden, Academic Teaching Hospital, Dresden, Germany
| | | | - Torello Lotti
- Department of Dermatology, University of Rome "G. Marconi", Rome, Italy
| | - Michael Tirant
- Department of Dermatology, University of Rome "G. Marconi", Rome, Italy
| | - Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital, Dresden, Germany
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Peckruhn M, Elsner P, Tittelbach J. Eosinophilic dermatoses. J Dtsch Dermatol Ges 2019; 17:1039-1051. [DOI: 10.1111/ddg.13943] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/19/2019] [Indexed: 12/27/2022]
Affiliation(s)
| | - Peter Elsner
- Department of DermatologyUniversity Hospital Jena Germany
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Zhu G, Liao W. Vesicles and Bullae on the Right Cheek, Neck, and Both Hands. JAMA Dermatol 2019; 155:617-618. [PMID: 30892568 DOI: 10.1001/jamadermatol.2018.5471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Guannan Zhu
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Wenjun Liao
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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25
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Abstract
Das Wells-Syndrom, auch als eosinophile Zellulitis bezeichnet, ist eine seltene, sporadisch auftretende eosinophile Dermatose mit polymorphem klinischem Bild. Als typisch gelten entzündliche Erytheme oder Plaques an den Extremitäten, die initial als Erysipel imponieren können, unter antimikrobieller Behandlung aber persistieren. Die eosinophile Zellulitis ist eine Ausschlussdiagnose, die in Zusammenschau von klinischem Befund und charakteristischem histologischem Bild (Flammenfiguren) nur im Verlauf gestellt werden kann. Mit einer Vielzahl möglicher Triggerfaktoren ist die Ätiologie nicht geklärt. Die Beteiligung abnormer Th2-Zellen, des Zytokins IL-5 und aktivierter eosinophiler Granulozyten lässt eine unspezifische Hypersensitivitätsreaktion auf exo- und endogene Stimuli vermuten. Die häufiger vorkommenden chronisch- rezidivierenden Formen lassen sich durch Glukokortikoide günstig beeinflussen. Der Verlauf ist meist selbstlimitierend, ohne Residuen. Aufgrund von Übergängen in hämatoonkologische Erkrankungen sind Verlaufskontrollen angezeigt.
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Affiliation(s)
- Andreas Benedikt Weins
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Ulm.,Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München
| | - Tilo Biedermann
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München
| | - Tina Weiss
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Ulm
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Abstract
A rare eosinophilic dermatosis, Wells syndrome, also referred to as eosinophilic cellulitis, is characterized by great clinical variability. Typical findings include infiltrated erythematous plaques arising on the extremities. Lesions initially resemble erysipelas/cellulitis, however, they do not improve with antibiotic treatment. Eosinophilic cellulitis is a diagnosis of exclusion that may only be made over the course of the disease, taking into account clinical and characteristic histological findings (flame figures). Although multiple potential triggers have been proposed, the exact etiology remains unresolved. Involvement of abnormal Th2 cells, IL-5, and activated eosinophilic granulocytes suggest a nonspecific hypersensitivity response to exogenous or endogenous stimuli. Corticosteroids may have a beneficial effect on the chronic, recurrent course frequently observed. The disease is often self-limiting, healing without sequelae. Given that transitions to hematological and oncological disorders have been observed, patients should be closely followed up.
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Affiliation(s)
- Andreas Benedikt Weins
- Department of Dermatology and Allergology, University Hospital Ulm, Ulm, Germany.,Department of Dermatology and Allergology, Biederstein Campus, Technical University Munich (TUM), Munich, Germany
| | - Tilo Biedermann
- Department of Dermatology and Allergology, Biederstein Campus, Technical University Munich (TUM), Munich, Germany
| | - Tina Weiss
- Department of Dermatology and Allergology, University Hospital Ulm, Ulm, Germany
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Safran T, Masckauchan M, Maj J, Green L. Wells syndrome secondary to influenza vaccination: A case report and review of the literature. Hum Vaccin Immunother 2018; 14:958-960. [PMID: 29240526 DOI: 10.1080/21645515.2017.1417714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Vaccinations have been shown repeatedly to be extremely safe with low incidence of complications. Given the rarity, these adverse events, they must be reported and examined cautiously. This case report illustrates the first case of an adult presenting with Wells syndrome that developed soon after vaccination with the thiomersal, a common preservative, containing influenza vaccine. Wells syndrome, also known as eosinophilic cellulitis, is an uncommon dermatologic condition of unknown etiology. Lesions in patients with Wells syndrome (eosinophilic cellulitis) progress over a few days to become large indurated plaques with associated edema and erythema. Although the etiology of Wells syndrome remains unknown, certain precipitants have been described in the literature, including but not limited to parasitic infections, contact dermatitis, Churg-Strauss disease and various medications. This article describes a possible sensitivity to thiomersal, as well as describes other cases that have reported a similar sensitivity secondary to receiving thiomersal-containing vaccines.
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Affiliation(s)
- Tyler Safran
- a Faculty of Medicine, McGill University , Montreal , Quebec , Canada
| | - Marina Masckauchan
- b Division of Internal Medicine, McGill University Health Center , Montreal , Quebec , Canada
| | - Jakub Maj
- b Division of Internal Medicine, McGill University Health Center , Montreal , Quebec , Canada
| | - Lawrence Green
- b Division of Internal Medicine, McGill University Health Center , Montreal , Quebec , Canada
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Cain CL, Bradley CW, Mauldin EA. Clinical and histologic features of acute-onset erythroderma in dogs with gastrointestinal disease: 18 cases (2005–2015). J Am Vet Med Assoc 2017; 251:1439-1449. [DOI: 10.2460/javma.251.12.1439] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Santos RP, Carvalho SD, Ferreira O, Brito C. Wells syndrome associated with lung cancer. BMJ Case Rep 2017; 2017:bcr-2017-220323. [PMID: 28951508 DOI: 10.1136/bcr-2017-220323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Wells syndrome (WS) or eosinophilic cellulitis is a rare, idiopathic, inflammatory dermatosis. The typical clinical presentation is urticarial plaque without preferential location that usually heals without scarring. We present a 62-year-old man with history of lung cancer that had undergone a right superior lobectomy 12 months previously. The patient had a relapsing dermatosis beginning about 6 months before the diagnosis of the lung cancer, characterised by pruritic, erythematous plaques located on the trunk and arms. These lesions spontaneously resolved within a few weeks without scarring. A skin biopsy revealed findings compatible with WS. Several diseases have been associated with WS. These include haematological diseases, fungal, parasitic and viral infections, drug reactions and rarely non-haematological malignancies. We present a case of this rare syndrome in a patient with history of lung cancer that we believe acted as a triggering event. To our knowledge, this is the second case reporting this association.
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Affiliation(s)
| | | | - Olga Ferreira
- Department of Dermatology, Hospital de Braga, Braga, Portugal
| | - Celeste Brito
- Department of Dermatology, Hospital de Braga, Braga, Portugal
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30
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Gallard C, Law-Ping-Man S, Darrieux L, Tisseau L, Safa G. Syndrome de Wells mimant une cellulite infectieuse de la face : trois observations. Ann Dermatol Venereol 2017; 144:284-289. [DOI: 10.1016/j.annder.2016.09.676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/22/2016] [Accepted: 09/14/2016] [Indexed: 10/20/2022]
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Lekić B, Gajić-Veljić M, Nikolić M. Granuloma Annulare-like Wells Syndrome in a Child - A Case Report. SERBIAN JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2017. [DOI: 10.1515/sjdv-2016-0008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Abstract
Wells syndrome (WS) is a rare inflammatory skin disease of unknown etiology. Possible triggers for WS include insect bites/stings, infections, medications, malignancies, and vaccination. Most cases have been reported in adults, but WS may also occur in children.
We report a case of idiopathic WS in a 12-year-old boy, who presented with pruritic papulonodular and granuloma annulare-like lesions on his legs. The patient had an excellent response to topical and systemic corticosteroids.
WS may present as plaque, granuloma annulare-like, urticaria-like, papulovesicular, bullous, papulonodular, or fixed drug eruption-like lesions. Erythematous annular lesions are most common in adults, while plaques are mostly found in children. The histopathologic features are dynamic, starting with dermal edema and infiltration of eosinophils, then flame figures develop, and finishing with the appearance of histiocytes and giant cells.
Our patient represents a rare pediatric case with granuloma annulare-like WS syndrome.
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Affiliation(s)
- Branislav Lekić
- Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, Republic of Serbia
| | - Mirjana Gajić-Veljić
- Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, Republic of Serbia
- University of Belgrade, School of Medicine, Belgrade, Republic of Serbia
| | - Miloš Nikolić
- Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, Republic of Serbia
- University of Belgrade, School of Medicine, Belgrade, Republic of Serbia
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Brun J, Chiaverini C, Bessis D, Bourrat E, Lasek-Duriez A, Hadj-Rabia S, Boralevi F, Lacour JP. [Wells Syndrome in children and atopy: Retrospective study of 11 cases and review of the literature]. Ann Dermatol Venereol 2015; 142:320-31. [PMID: 25846461 DOI: 10.1016/j.annder.2015.02.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 01/20/2015] [Accepted: 02/04/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Well's syndrome, or eosinophilic cellulitis, is rare in childhood, with fewer than 40 pediatric cases being reported since 1979. The physiopathology is unknown. PATIENTS AND METHODS In February 2012, members of the research group of the Department of Pediatric Dermatology Society submitted their case of Wells' syndrome in children aged 0-15 years. Details of clinical, biological and histological features and of therapeutic strategies were collected by physicians using a standardized questionnaire. Pictures were reviewed by the authors. RESULTS Eleven patients were included (average age: 6 years), with a strong prevalence of atopy (63%). Two types of clinical manifestation were noted: single or multiple cellulitis associated or not with vesiculobullous lesions and fixed urticaria. Eighty-two percent of patients had pruritus and 73% had eosinophilia. For all patients, histological examination of skin biopsies showed an eosinophilic infiltrate extending in the dermis with associated Sweet-like neutrophilic infiltrate being seen in 2 patients. The course of the disease was protracted (mean duration: 8 months) with flare-ups. Treatment varied depending on the doctors (topical or systemic steroids, tacrolimus and dapsone). DISCUSSION Our study confirms some of the data in the literature concerning the clinical, histological features and course of Well's syndrome in children. The key information is the high prevalence of atopic children hitherto unreported. In a setting of insect bites, vaccination, infection or traumatism, this unusual background could explain the onset of inflammatory reaction with eosinophils. Oral or topical steroids appear to be the first-line treatment in children when necessary. CONCLUSION Well's syndrome in children is rare and characterized by its polymorphism. We report for the first time in a series of patients a high prevalence of atopy, which raises new perspectives in understanding these rare diseases. We propose topical steroids as first-line therapy in children with superficial lesions, with oral steroids being given for cellulitic lesions or where topical therapy fails.
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Affiliation(s)
- J Brun
- Dermatologie, hôpital l'Archet 2, CHU de Nice, BP 3079, 06202 Nice cedex 3, France; Pédiatrie, hôpitaux pédiatriques, CHU-Lenval, 57, avenue de la Californie, 06200 Nice, France
| | - C Chiaverini
- Dermatologie, hôpital l'Archet 2, CHU de Nice, BP 3079, 06202 Nice cedex 3, France; Pédiatrie, hôpitaux pédiatriques, CHU-Lenval, 57, avenue de la Californie, 06200 Nice, France.
| | - D Bessis
- Dermatologie, hôpital Saint-Eloi, CHU de Montpellier, 34295 Montpellier cedex 5, France
| | - E Bourrat
- Dermatologie, hôpital Robert-Debré, AP-HP, 75935 Paris cedex 19, France
| | - A Lasek-Duriez
- Dermatologie, hôpital Saint-Vincent, CHRU de Lille, 59037 Lille cedex, France
| | - S Hadj-Rabia
- Dermatologie, hôpital Necker, AP-HP, 75015 Paris, France
| | - F Boralevi
- Dermatologie, hôpital Pellegrin, CHU de Bordeaux, 33076 Bordeaux, France
| | - J-P Lacour
- Dermatologie, hôpital l'Archet 2, CHU de Nice, BP 3079, 06202 Nice cedex 3, France
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