Eosinophilic cellulitis (Wells' syndrome) associated with colon carcinoma

Eosinophilic cellulitis (Wells' syndrome) is an inflammatory dermatosis characterized by marked eosinophilic infiltrates. Drugs and various infections are recognized causes of eosinophilic cellulitis. Eosinophilic cellulitis has been reported in non‐hematological malignancies in two patients with squamous cell carcinoma and one with nasopharyngeal carcinoma. We report the association of eosinophilic cellulitis with adenocarcinoma of the colon. Curative hemicolectomy led to a complete remission, suggesting that underlying malignancies can trigger eosinophilic cellulitis.     

Eosinophilic cellulitis successfully treated with Methotrexate

Eosinophilic cellulitis is a rare inflammatory skin disease of unknown aetiology, first described by George Wells in 1971 as a recurrent granulomatous dermatitis with eosinophilia. It is typically characterised by recurrent pruritic erythematous plaques, vesicles or bullae usually involving the extremities and trunk. Many cases of eosinophilic cellulitis are difficult to treat and traditionally require long course of oral steroids, resulting in steroid side effects. This case adds to the literature in that we report the use of methotrexate to treat eosinophilic cellulitis, as a safe and efficacious therapeutic alternative.     

Eosinophilic fasciitis and eosinophilic cellulitis in a patient with abnormal circulating clonal T cells: increased production of interleukin 5 and inhibition by interferon alfa

Eosinophilic fasciitis (Shulman's syndrome) and eosinophilic cellulitis are part of a spectrum of diseases characterized by tissue and peripheral blood eosinophilia. Eosinophils are implicated directly in the lesional process that characterizes these conditions, because signs of eosinophil activation and degranulation are observed at the sites of tissue injury. The cause and pathogenesis of eosinophilic fasciitis and cellulitis are presently unclear. Herein, we report a patient manifesting rapidly progressive localized cutaneous induration of the arms and legs with eosinophilia, no signs of systemic sclerosis, and histopathologic features compatible with the diagnosis of eosinophilic fasciitis. Four years after the onset of eosinophilic fasciitis, the patient had recurrent episodes of eosinophilic cellulitis. Blood screening for clonal T-cell receptor gamma gene rearrangements revealed several amplified clonal populations of circulating T cells. Furthermore, in vitro analysis of cytokine production by the patient's peripheral blood mononuclear cells demonstrated strongly increased production of interleukin 5, the synthesis of which could be completely blocked by interferon (IFN)-alpha. The coexistence of eosinophilic fasciitis and cellulitis in a patient with an abnormal circulating T-cell clone and increased IL-5 production are unique and might be responsible for the eosinophilia and eosinophil-mediated tissue injury. Although not assessed in vivo in this patient, our in vitro data provide a rationale for the use of IFN-alpha in eosinophilic fasciitis and/or cellulitis.     

Wells' syndrome: a clinical and histopathologic review of seven cases

Wells' syndrome, or eosinophilic cellulitis, is characterized clinically by an acute dermatitis resembling cellulitis, which evolves into violaceous plaques that resolve spontaneously without scarring. The histopathologic features are dynamic, starting with dermal edema and infiltration of eosinophils, the development of "flame figures," and finishing with the appearance of phagocytic histiocytes. We present the clinical and histopathologic features of seven cases of eosinophilic cellulitis.     

Eosinophilic cellulitis (Wells' syndrome): histologic and clinical features in arthropod bite reactions

Five patients are described with the clinical and histopathologic picture, including flame figures, of eosinophilic cellulitis (Wells' syndrome). Two of them had documented tick bites in the center of these expanding annular lesions, and the histologic picture showed the diagnostic flame figures of Wells' syndrome (eosinophilic cellulitis). A third patient had a clinical picture suggestive of a tick bite reaction but stated she was stung by a small garden bee at the involved site. The fourth patient removed a spider from the site of a spider bite, and this nodule also histopathologically was identical to that of eosinophilic cellulitis. Our fifth patient presented with papular urticaria of flea bites. We suggest that the characteristic flame figures of eosinophilic cellulitis (Wells' syndrome) are not diagnostic of a specific disease entity but rather a striking and peculiar histopathologic response to multiple factors of which arthropod bites (ticks, bees, fleas, and spiders) represent one definite etiology.     

Eosinophilic cellulitis of papulonodular presentation (Wells'' syndrome)

Eosinophilic cellulitis (Wells' syndrome) is a rare condition of unknown aetiopathogenesis and is characterized by erythemal plaques and a histological picture of eosinophilic infiltration of the dermis with 'flame' figures. Here we describe a patient with the papulonodular variant of eosinophilic cellulitis associated with an unusual hepatic dysfunction.     

Eosinophilic cellulitis presented with semicircular pattern

Eosinophilic cellulitis (Wells' syndrome) is a rare condition of unknown etiology and pathogenesis. It is characterized by erythematous plaques and a histological picture of dermal eosinophilic infiltration with "flame figures". The typical clinical presentation of eosinophilic cellulitis is mildly pruritic cellulite-like plaques. Urticarial, vesiculo-bullous, nodular and papulonodular variants were also reported. Herein, we describe a patient with annular and semicircular manifestations of eosinophilic cellulitis. It was treated successfully with low-dose cyclosporine A treatment.     

Hypereosinophilic syndrome with various skin lesions and juvenile temporal arteritis

Hypereosinophilic syndrome (HES) is a multisystem disease with a high mortality rate. It is characterized by peripheral blood eosinophilia and eosinophilic infiltration of the skin and many other organs. The commonest cutaneous features include erythematous pruritic maculopapules and nodules, angio-oedema or urticarial plaques. However, some case reports have indicated that eosinophilic cellulitis, cutaneous necrotizing eosinophilic vasculitis, Raynaud's phenomenon and digital gangrene may also occur as cutaneous features of HES. Juvenile temporal arteritis (JTA) of unknown cause is characterized by an asymptomatic nodule in the temporal artery area in young adults. Histologically, the lesion is characterized by a significant intimal thickening with moderate eosinophilic infiltrates, constriction or occlusion of the vascular lumen and absence of giant cells. We report a patient with HES presenting with eosinophilic cellulitis, Raynaud's phenomenon, digital gangrene and JTA. JTA may also be one of the features of HES.     

Eosinophilic cellulitis: five cases

Five cases of eosinophilic cellulitis or Wells' syndrome are described. While only few children have been included in earlier reports, 4 of the 5 patients in the present paper were below 10 years of age, with the youngest being only 20 months when the disease started. One of the children developed hard and tender subcutaneous swellings on the scalp, the histology of which showed extensive subcutaneous necrotizing granulomas. Similar lesions have not been described previously in connection with eosinophilic cellulitis. Eosinophilic cellulitis may be called a rare disease. However, it is important that clinician and histopathologist are both acquainted with the pathological features of this condition, as the disease often responds readily to steroid therapy.     

Eosinophilic cellulitis associated with urticaria. A report of two cases

Two patients with the clinical and histopathologic findings of eosinophilic cellulitis are presented. In one patient there was a definite relationship between upper respiratory tract infection and flare-ups of eosinophilic cellulitis. This patient's condition was superimposed on a long history of chronic urticaria. In the other patient a relationship to recurrent sinusitis was possible but not definite. There were no other contributory underlying skin diseases in either patient. Eosinophilic cellulitis is not likely a disease entity as such but, instead, represents a severe urticarial hypersensitivity reaction to various stimuli. Collagen alteration by eosinophil granules results in flame figure formation and a granulomatous response, which may explain the prolonged persistence of the lesions.     

Eosinophilic Cellulitis (Wells'' Syndrome)

Two patients with eosinophilic cellulitis are reported and 22 additional cases from the literature are reviewed. Cutaneous lesions are variable in appearance and may be confused with cellulitis, urticaria, insect bites, or contact dermatitis. Microscopically, there is a dense dermal infiltrate of eosinophils. Subsequently, granulomatous features with characteristic "flame figures" become apparent. Peripheral eosinophilia is common. The etiology of eosinophilic cellulitis is unknown, although a hypersensitivity mechanism is suspected. Treatment with systemic corticosteroids is frequently effective, but the disease is often characterized by relapses that can occur for several years.     

Wells syndrome

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.     

Increased concentrations of immunoreactive leukotrienes in cutaneous lesions of eosinophilic cellulitis

A case of eosinophilic cellulitis is described. Tests of eosinophil function were normal. Radioimmunoassay identification of inflammatory mediators showed greatly increased concentrations of leukotrienes LTC₄/D₄ (components of slow-reacting substance of anaphylaxis) in the affected skin. These mediators may play a causal role in the inflammation seen with eosinophilic cellulitis.     

Bullous eosinophilic cellulitis succession with eosinophilic pustular folliculitis without eosinophilia

Eosinophilic cellulitis is characterized clinically by an acute dermatitis resembling cellulitis with unknown etiology. Eosinophilic pustular folliculitis is also a rare inflammatory dermatosis characterized by recurrent crops of erythematous follicular papulopustules that coalesce to form annular plaques with unclear etiopathogenesis. We describe a 20-year-old white male who had vesiculobullous and plaque-like lesions on the hands and feet and was diagnosed with bullous eosinophilic cellulitis clinically and histologically without any etiological agents. Following therapy with oral corticosteroid and oral tetracycline capsules, the lesions disappeared. After a 2-month asymptomatic period, the patient developed pruritic follicular papules and pustules on the lower and upper extremities and upper back. Stool examination revealed Gierdia intestinalis eggs. The patient had complete clearance with treatment of ornidazol for 2 weeks and indomethacin for 2 months. This is the first report of bullous eosinophilic cellulitis coexisting with eosinophilic pustular folliculitis without eosinophilia in the English published work.     

Dermatosis eosinofílicas (I)

The eosinophil is an effector cell of the immune response with important affinity for the tissues. Skin diseases characterized by a dermal infiltration of eosinophils constitute an apparently heterogeneous group. We review the characteristic features of such well-defined entities, known as eosinophilic dermatoses.In the first part of this work we included eosinophilic pustular folliculitis, eosinophilic cellulitis, angiolymphoid hyperplasia with eosinophilia, granuloma faciale, eosinophilic ulcer of the tongue, papuloerythroderma and the pachydermatous eosinophilic dermatitis.In analogy to the accepted unifying concept of neutrophilic dermatosis, we will discuss the possible pathogenic unity of this group of diseases.     

Eosinophilic Cellulitis (Wells' Syndrome)

Abstract: Two patients with eosinophilic cellulitis are reported and 22 additional cases from the literature are reviewed. Cutaneous lesions are variable in appearance and may be confused with cellulitis, urticaria, insect bites, or contact dermatitis. Microscopically, there is a dense dermal infiltrate of eosinophils. Subsequently, granulomatous features with characteristic "flame figures" become apparent. Peripheral eosinophilia is common. The etiology of eosinophilic cellutitis is unknown, although a hypersensitivity mechanism is suspected. Treatment with systemic corticosteroids is frequently effective, but the disease Is often characterized by relapses that can occur for several years.     

Eosinophilic cellulitis

Eight cases of eosinophilic cellulitis are described with acute cutaneous swellings followed by indolent infiltration. The histology is distinctive with focal phagocytosis of eosinophilic material in dermis. Occasionally these histological features are observed in other inflammatory dermatoses when eosinophils have infiltrated the connective tissue.     

Eosinophilic cellulitis (Well''s Syndrome) with florid histological changes

A patient with eosinophilic cellulitis showing unusually variable cutaneous lesions and gross histological changes is described.     

Bullous Eosinophilic Cellulitis in a Child Treated with Dapsone

Abstract: Eosinophilic cellulitis, or Wells syndrome, is a rare but well‐described condition in which bullous lesions are uncommon, especially in childhood. We report a case of bullous eosinophilic cellulitis recalcitrant to steroid therapy in a 9‐year‐old boy who was successfully treated with oral dapsone.     

Eosinophilic cellulitis (Wells' syndrome) in association with angioimmunoblastic lymphadenopathy

Eosinophilic cellulitis (Wells' syndrome) is an uncommon inflammatory disease with clinical polymorphism. It is often associated with infectious, allergic or myeloproliferative diseases; however, the exact aetiology is unknown. This report describes a rare case of eosinophilic cellulitis in association with angioimmunoblastic lymphadenopathy. The typical skin findings of Wells' syndrome disappeared completely following chemotherapy and autologous stem cell transplantation.