Eosinophilie cellulitis (Wells' syndrome): Histologic and clinical features in arthropod bite reactions

Schorr, William F.; Tauscheck, Aloys L.; Dickson, Kenneth B.; Melski, John W.

doi:10.1016/s0190-9622(84)70257-x

Cited by 85 publications

(38 citation statements)

References 8 publications

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“…However, in approximately one half of reported cases among children, there is no identifiable precipitating factor. 24 Reported precipitants have included bites or stings from ticks, bees, and spiders 8,9,12,[25][26][27][28] and infections with mumps, molluscum contagiosum, varicella, and herpes simplex virus. 1,24,29,30 There are also several reports of Wells' syndrome associated with bacterial, parasitic, and fungal infections.…”

Section: Discussionmentioning

confidence: 99%

Bullous “Cellulitis” With Eosinophilia: Case Report and Review of Wells' Syndrome in Childhood

Gilliam¹,

Bruckner

Howard³

et al. 2005

Pediatrics

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ABSTRACT. A 1-year-old girl presented with acute onset of edematous erythematous plaques associated with bullae on her extremities and accompanied by peripheral eosinophilia. She was afebrile, and the skin lesions were pruritic but not tender. The patient was treated with intravenously administered antibiotics for presumed cellulitis, without improvement. However, the lesions responded rapidly to systemic steroid therapy. On the basis of lesional morphologic features, peripheral eosinophilia, and cutaneous histopathologic features, a diagnosis of Wells' syndrome was made. Wells' syndrome is extremely rare in childhood, with 27 pediatric cases reported in the literature. Because it is seen so infrequently, there are no specific guidelines for evaluation and management of Wells' syndrome among children. W ells' syndrome, or eosinophilic cellulitis, is a rare, recurrent, inflammatory dermatosis of unknown pathogenesis. In 1971, Wells 1 described 4 patients with an acute pruritic dermatitis clinically resembling bacterial cellulitis but with histopathologic findings characterized by dermal eosinophilia, phagocytic histiocytes, and the presence of flame figures. He initially called this syndrome recurrent granulomatous dermatitis with eosinophilia but later simplified the name to eosinophilic cellulitis. 2 Wells' syndrome is seen more commonly among adults but has been observed among children. Some hypothesize that this syndrome may represent a hypersensitivity response to a circulating antigen. 2 Associated precipitants include insect bites, medication reactions, recent immunization, myeloproliferative disorders, malignancies, and infections. We describe a case of a young child with no identifiable triggering factors, and we review the evidence for evaluation and management of these pediatric cases. CASE REPORTA previously healthy, 1-year-old girl presented with acute onset of edematous erythematous plaques, with associated bullae, on her lower extremities and left arm (Fig 1). These lesions were pruritic but not painful, and the patient was afebrile. Her parents denied a history of insect bites, ingestion of medications, trauma, or other intercurrent illness. The patient's most recent immunizations had been received 3 months earlier. The patient did not have a history of asthma, and there was no family history of asthma or atopic disease.The patient was admitted with presumed bacterial cellulitis and was treated with intravenously administered oxacillin, without improvement. Her laboratory studies were significant for an elevated white blood cell count of 30 ϫ 10 9 cells per L, with peripheral eosinophilia of 48%. After the patient failed to respond to systemically administered antibiotics, examination of vesicle fluid was performed and revealed numerous eosinophils. Subsequently, the diagnosis of probable Wells' syndrome was made. Oral steroid therapy was started at 2 mg/kg, and the patient's cutaneous symptoms improved within 24 hours, leaving residual erythema and hyperpigmentation (Fig 2). Five days after the i...

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Section: Discussionmentioning

confidence: 99%

Bullous “Cellulitis” With Eosinophilia: Case Report and Review of Wells' Syndrome in Childhood

Gilliam¹,

Bruckner

Howard³

et al. 2005

Pediatrics

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“…The dense superficial and deep dermal inflammatory infiltrate was mixed and consisted of numerous eosinophils. Although an eosinophilic cellulitis was considered, 1 a hypersensitivity response to an arthropod bite was favored (Figure 1, B and C ). …”

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confidence: 99%

Seventeen-year-old girl hospitalized for localized swelling, pruritus, tenderness, and lymphatic streaking with eosinophilia

Kennedy

Jeffus

Platts-Mills

et al. 2013

The Journal of Allergy and Clinical Immunology: In Practice

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“…Etiyolojik nedenler aç s ndan de erlendirildi inde literatürde bildirilen olgular n yakla k yar s nda herhangi bir etiyolojik neden saptanmam t r. Etiyolojik neden bildirilen 14 olgudan dördünde böcek s r (7,16,17,19), üç olguda k zam k, suçiçe i ve erizipel gibi enfeksiyonlar (9,22), bir olguda ise hepatit ve difteri-bo maca-tetanoz a s (10), iki olguda annenin gebeli i s ras nda kulland ilaç kullan m (danazol ve penisilin) (12,14), bir olguda molluskum kontagiozum tedavisi için uygulanan kriyoterapi (26) olas tetikleyici faktör-ler olarak gösterilmi tir. ki olguda ise ailede de eozinofilik sellülit tan s olmas nedeniyle genetik geçi olabilece i belirtilmi ve bu iki olguda eozinofilik sellülite e lik eden mental retardasyon ve k sa boy, yüksek ayak ark , k sa ve kal n parmaklar gibi anormal vücut yap s bildirilmi tir (20).…”

Section: Tart Maunclassified

Eosinophilic Cellulitis: An 11-Year-Old Male Patient

Sezgin¹,

Erçal²,

Karaarslan³

et al. 2010

Turk J Dermatol

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On bir yaşında erkek hasta, sağ kruris ön yüzünde, sağ popliteal bölge iç medialinde ve sol kruris ön yüzünde yerleşimli, yaklaşık üç haftadır var olan, açık kahverengi, infiltratif plaklar nedeniyle kliniğimize başvurdu. Lezyonların histopatolojik incelemesinde kollajen liflerin üzerine dejenere eozinofil ve nükleus kalıntılarının çökmesiyle oluşan alev figürleri ve laboratuar tetkiklerinde eozinofili saptandı. Klinik ve histopatolojik veriler eşliğinde granülomatöz fazın izlendiği "eozinofilik sellülit" tanısı koyuldu. Olgu, eozinofilik sellülitin çocuklarda çok nadir rastlanan bir tablo olması nedeni ile sunulmuş ve histopatolojinin tanıda önemi vurgulanmıştır. ( AbstractAn 11-year-old boy was admitted to our clinic with a three-week of history of infiltrated brownish plaques located on the right cruris anterior, on the medial side of the right popliteal area and on the left cruris anterior. Histopathological examination showed flame figures which were composed of degenerated eosinophils and nuclear debris deposited on collagen fibers and laboratory analysis revealed eosinophilia. According to the clinical and histopathological findings, the case was diagnosed as eosinophilic cellulitis in the granulomatous phase. The case has been reported because of the rare presentation of eosinophilic cellulitis in children and the importance of the histopathology has been emphasized. (Turk J Dermatol 2010; 4: 40-3)

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Eosinophilie cellulitis (Wells' syndrome): Histologic and clinical features in arthropod bite reactions

Cited by 85 publications

References 8 publications

Bullous “Cellulitis” With Eosinophilia: Case Report and Review of Wells' Syndrome in Childhood

Bullous “Cellulitis” With Eosinophilia: Case Report and Review of Wells' Syndrome in Childhood

Seventeen-year-old girl hospitalized for localized swelling, pruritus, tenderness, and lymphatic streaking with eosinophilia

Eosinophilic Cellulitis: An 11-Year-Old Male Patient

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