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Hendra Gunawan, Zulfan Zulfan Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin Hospital, Bandung, IndonesiaCorrespondence: Hendra Gunawan, Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Jl. Pasteur 38, Bandung, West Java, 40161, Indonesia, Tel +6281221111215, Email h.gunawan2016@unpad.ac.idAbstract: Wells’ syndrome is a rare inflammatory skin disease characterized by pruritic erythematous lesions and cutaneous edema, often accompanied by eosinophilia. Parasitic infestations, such as toxocariasis and strongyloidiasis, can serve as triggers. However, Wells’ syndrome associated with toxocariasis and strongyloidiasis has not been reported previously in Indonesia. Herein, we present a case of a 27-year-old male with a chief complaint of recurrent, pruritic, and painful erythematous rash on the right lower leg for 6 months, accompanied by fever and diarrhea. Physical examination showed cutaneous edema with erythematous macules and bullae on the affected leg. Peripheral blood eosinophilia was noted, and the histopathological analysis demonstrated flame figures, confirming the diagnosis of Wells’ syndrome. A stool culture identified Strongyloides stercoralis, confirming strongyloidiasis, and serological testing was positive for toxocariasis immunoglobulin G antibodies. The patient was treated with albendazole 400 mg twice daily for 3 weeks resulted in clinical improvement observed by the 14th day. The diverse clinical features of Wells’ syndrome present a challenge to clinicians in making an accurate diagnosis, which typically hinges on histopathological assessment and identifying flame figures. Therefore, clinicopathological correlation is important to establish an accurate diagnosis.Keywords: strongyloidiasis, toxocariasis, Wells’ syndrome

Introduction: Many conditions included under figurate erythemas have similar clinical appearance which makes diagnosis difficult. Among these, eosinophilic annular erythema (EAE) is a rare, uncommon, underreported entity in the pediatric population. Case Report: Herein, we report an 11-year-old boy who presented with asymptomatic recurrent, erythematous-edematous annular plaques with central hyperpigmentation. Discussion: Review of the literature shows scarce reporting of such cases globally and none from India. Clinicopathological findings of our case, suggest that eosinophilic annular erythema is a distinct entity rather than a type of Wells' syndrome.

A 55-year-old woman presented with a 3-year history of recurrent episodes of pruritic cellulitis-like erythematous plaques, mostly located on the limbs. Simultaneously, fever, malaise and peripheral eosinophilia were noted. The clinical diagnosis of eosinophilic cellulitis (also known as Well’s syndrome) was supported by the histopathological finding of typical “flame figures”. Treatment with dapsone was initiated at a dose of 50 mg per day. After one year of follow-up the patient was relapse-free. Eosinophilic cellulitis is an uncommon, recurrent inflammatory skin disease. The management is often a challenge, due to the frequent need for long-term therapy. Dapsone is an effective and safe treatment option.

Wells' syndrome, or eosinophilic cellulitis, is an inflammatory disease of unknown origin, uncommon in the pediatric age. It usually appears clinically as erythematous and edematous plaques, nodules, papules, blisters, among other symptoms. Here we describe the case of a female pediatric patient with generalized, asymptomatic subcutaneous nodules associated with severe eosinophilia. The histopathological examination of the lesions was compatible with Wells' syndrome. An interdisciplinary evaluation was performed to establish the cause and look for associated eosinophilic disorders; the results were negative. Systemic corticosteroids were indicated and the patient had a good response; however, in view of the recurrence of the lesions after treatment discontinuation, dapsone was indicated as a second-line treatment, with subsequent improvement of the lesions and eosinophilia. The aim of this report was to describe the case of a female patient with an atypical manifestation of Wells' syndrome and the resulting therapeutic challenge., (Sociedad Argentina de Pediatría.)

Introduction: Many conditions included under figurate erythemas have similar clinical appearance which makes diagnosis difficult. Among these, eosinophilic annular erythema (EAE) is a rare, uncommon, underreported entity in the pediatric population. Case Report: Herein, we report an 11-year-old boy who presented with asymptomatic recurrent, erythematous-edematous annular plaques with central hyperpigmentation. Discussion: Review of the literature shows scarce reporting of such cases globally and none from India. Clinicopathological findings of our case, suggest that eosinophilic annular erythema is a distinct entity rather than a type of Wells' syndrome. [ABSTRACT FROM AUTHOR]

Wells’ syndrome, also called eosinophilic cellulitis, is a rare eosinophilic dermatosis characterized by an unspecific inflammatory erythematous eruption often associated with systemic symptoms. Here we report the case of a 57-year-old female with bilateral painful pitting and pruritic feet progressive for two weeks despite one week of oral antibiotics. Skin biopsy was performed showing dermal eosinophilic infiltration. The patient showed a spontaneous progressive improvement of the condition. The presented case demonstrates both clinical and histologic presence of lesions of Wells’ syndrome in the course of the disease. A careful diagnostic approach is needed because of the lack of specific signs. The global outcome is favorable and spontaneous resolution is possible.

AIM: In this study, we aimed to review the diagnostic approach to eosinophilic cell renal neoplasms by light microscopy and immunohistochemical techniques. METHOD: In this study 23 of these tumors were eosinophilic variant classic RCC, 15 eosinophilic variant papillary RCC, 13 eosinophilic variant chromophobe RCC and 13 oncocytoma cases. These tumors were immunohistochemically treated with CK7, CD117, EpCAM, Vimentin, RCCm (Renal cell carcinoma marker) and GST-a. RESULTS: In our study, contrary to the general literature on Vimentin, 65.2% negativity was found in our patients with eosinophilic variant classic RCC. However, when compared with other tumor types in our study, vimentin expression was highest in eosinophilic variant classical RCC with 34.8%. Statistically; RCCm, GST-a, EpCAM, CD117, CK7 were found to be significantly associated with tumor types, while no significant relationship was found between Vimentin and tumor types. RCCm positivity and CK7 and CD117 negativity were in favour of eosinophilic variant classical RCC, EpCAM, CK7 and CD117 positivity and Vimentin, GST-a and RCCm negativity supported eosinophilic variant chromophobe RCC, CK7 and RCCm positivity and CD117 and GST-a negativity were found in favour of eosinophilic variant papillary RCC. CD117 positivity and Vimentin, CK7 and GST-a negativity were found to support oncocytoma. CONCLUSIONS: The panel with RCCm, GST-a, EpCAM, CD117, CK7 will contribute to the differentiation of eosinophilic cytoplasm renal tumors that cannot be determined by morphological fi ndings and to reach the correct diagnosis (Tab. 3, Fig. 4, Ref. 54). Text in PDF www.elis.sk. [ABSTRACT FROM AUTHOR]

Eosinophilic cellulitis is an uncommon, inflammatory and chronic disorder of unknown etiology. Corticosteroids are currently considered as the first-line treatment but they are not without significant disadvantages such as contraindications in steroid-resistant cases and patients with frequent recurrences. We report a patient suffering from Wells’ syndrome with a 24-year history of symptomatic and generalized skin lesions. After consultation in our department, treatment with colchicine 1 mg/day was prescribed resulting in large clinical improvement. No side effects have been recorded. To our knowledge, this is an original disease approach. Although small, our clinical experience supports the inclusion of colchicine in the drug armamentarium when treating patients suffering from Wells’ syndrome. Indeed, its excellent safety profile makes it very attractive for patients with frequent recurrent episodes who need secure options for the medium- and long-term disease control.

A 5-year-old boy was referred because of urticarial flares with angioedema. Antihistamines and systemic steroids were not useful to prevent flares. At examination, at distance of a flare, chronic red-brownish plaques were found on the legs, trunk, and back, resembling granuloma annulare. The skin biopsy showed epithelioid and giant-cell granulomas, elastophagia, and “flames figures” surrounded with many eosinophils. A diagnosis of disseminated granuloma annulare-like variant of Wells' syndrome as described earlier by Caputo was made. A treatment with dapsone was initiated and enabled to stop flares. Wells' syndrome is a rare clinicopathologic entity with a chronic benign course and often misleading clinical presentation. Our case illustrates the clinical polymorphism and benefit of dapsone therapy.

Eosinophilic annular erythema (EAE) is a rare entity of unknown etiology that is possibly related to a hypersensitivity reaction and presents as annular erythematous plaques with tissue eosinophilia. It is classified as a figurate erythema with a controversial relationship to Wells syndrome (WS) in the literature, where it is generally considered a separate entity or subset based on clinical and histopathologic differences. EAE typically presents with recurrent, erythematous, arcuate, and annular plaques on the trunk and proximal extremities. The course of the disease is often chronic, recurrent, and relapsing. Responses to treatment are variable but are typically best with systemic steroids and antimalarials. We report a patient refractory to other therapies who had a striking response to dapsone. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To describe the clinical and histologic features of acute erythroderma in dogs with gastrointestinal disease. DESIGN: Retrospective case series. ANIMALS: 18 dogs with erythroderma and gastrointestinal disease. PROCEDURES: Medical records and biopsy specimens were reviewed. Information collected from medical records included signalment, clinical signs, physical examination and diagnostic test results, treatment, and outcome. The Naranjo algorithm was used to estimate the probability of an adverse drug reaction for each dog. RESULTS: All dogs had an acute onset of erythematous macules or generalized erythroderma. Histologic features of skin biopsy specimens had 3 patterns representing a progressive spectrum of inflammation. Most dogs had vomiting (n = 17) and hematochezia (10). Signs of gastrointestinal disease became evident before, after, or concurrent with the onset of skin lesions in 10, 3, and 5 dogs, respectively. Inflammatory bowel disease, pancreatitis, and adverse food reaction were diagnosed in 5, 3, and 3 dogs, respectively. The cause of the gastrointestinal signs was not identified for 8 dogs. Eight dogs had a Naranjo score consistent with a possible adverse drug reaction. Treatment of skin lesions included drug withdrawal (n = 15), antihistamines (16), and corticosteroids (14). Signs of gastrointestinal disease and skin lesions resolved at a mean of 4.6 days and 20.8 days, respectively, after onset. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated acute erythroderma may be associated with > 1 gastrointestinal disease or an adverse drug reaction in some dogs. Recognition of the clinical and histologic features of this syndrome is essential for accurate diagnosis. [ABSTRACT FROM AUTHOR]

Eosinophilic cellulitis is an uncommon, inflammatory and chronic disorder of unknown etiology. Corticosteroids are currently considered as the first-line treatment but they are not without significant disadvantages such as contraindications in steroid-resistant cases and patients with frequent recurrences. We report a patient suffering from Wells' syndrome with a 24-year history of symptomatic and generalized skin lesions. After consultation in our department, treatment with colchicine 1 mg/day was prescribed resulting in large clinical improvement. No side effects have been recorded. To our knowledge, this is an original disease approach. Although small, our clinical experience supports the inclusion of colchicine in the drug armamentarium when treating patients suffering from Wells' syndrome. Indeed, its excellent safety profile makes it very attractive for patients with frequent recurrent episodes who need secure options for the medium- and long-term disease control. [ABSTRACT FROM AUTHOR]

Mott cells are a variant form of plasma cells in humans and laboratory animals. This report describes the morphological characteristics of Mott cells observed in a 33-week-old female CB6F1-Tg rasH2 mouse. Microscopically, a large number of round cells with abundant eosinophilic globules, which were variable in size, were observed in the spleen and were densely distributed in the red pulp adjacent to the marginal zone. A few similar cells were present in the submandibular lymph node and bone marrow. Neither systemic nor local chronic inflammatory changes were seen in this animal. These cells were positive for mouse immunoglobulins. Ultrastructurally, the dilated rough endoplasmic reticulum had a homogenous substances with an intermediate electron density. On the basis of the above findings, these cells were identified as Mott cells. The present lesion is thought to be a spontaneous lesion, an unusual appearance of Mott cells without any associated pathological conditions. [ABSTRACT FROM AUTHOR]

Wells syndrome, part of eosinophilic dermatosis, is characterized by infiltrated plaques with edema and erythema, which resolve without scarring and are accompanied by peripheral blood eosinophilia. Familial cases have been described.We report a case of this group of rare dermatosis, pathological studies are essential for diagnosing as clinically encountered numerous differential diagnoses. [ABSTRACT FROM AUTHOR]

Wells' syndrome (WS), or eosinophilic cellulitis, is an uncommon inflammatory dermatosis of unknown etiology that typically presents with pruritic cellulitis-like plaques on the extremities. Therefore, WS is often misdiagnosed as bacterial cellulitis due to its similarity in presentation. Here, we report two cases of WS that masqueraded as bacterial facial cellulitis. Under treatment with oral prednisone and/or a combination therapy with levocetirizine and hydroxyzine, both patients showed a dramatic improvement of the skin lesions. These cases highlight the need for clinicians to consider WS in the differential diagnosis when evaluating a patient with facial cellulitis that does not respond to an initial antimicrobial regimen. In addition, our cases suggest that combination therapy with levocetirizine and hydroxyzine may be successfully used as corticosteroid-sparing treatment or to prevent relapse after the discontinuation of corticosteroid treatment. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Stings by honeybees are not uncommon and most cases cause pain but no significant medical problems. Some patients, however, have lethal complications such as acute anaphylactic shock. Cellulitis caused by honeybee sting is very rare and can be a late complication in some patients. We report a 45-year-old female patient who was stung by a honeybee, and whose right forearm showed progressive swelling with bullous formation after the sting. She was sent to our emergency department with the diagnosis of right hand cellulitis. After treatment with antibiotics for 5 days, the lesions showed no response. Then, systemic steroid was used and the lesion gradually resolved. Diagnosis of Wells' syndrome was made according to clinical appearance, course and characteristic histopathological findings.

A 5-year-old boy was referred because of urticarial flares with angioedema. Antihistamines and systemic steroids were not useful to prevent flares. At examination, at distance of a flare, chronic red-brownish plaques were found on the legs, trunk, and back, resembling granuloma annulare. The skin biopsy showed epithelioid and giant-cell granulomas, elastophagia, and "flames figures" surrounded with many eosinophils. A diagnosis of disseminated granuloma annulare-like variant of Wells' syndrome as described earlier by Caputo was made. A treatment with dapsone was initiated and enabled to stop flares. Wells' syndrome is a rare clinicopathologic entity with a chronic benign course and often misleading clinical presentation. Our case illustrates the clinical polymorphism and benefit of dapsone therapy. [ABSTRACT FROM AUTHOR]

Background We report a case of a 33-year-old man who presented with immunoglobulin (Ig)G4-related disease (IgG4-RD) forming a pseudotumor in the left paratesticular region during oral administration of corticosteroid for Wells syndrome, which involves cellulitis with eosinophilia. Case presentation The patient was introduced to our institution from a private hospital with a 3-month history of asymptomatic left scrotal mass. A 5-cm diameter nodule was palpable in the left scrotum. Tumor lesion in the left paratestis involving the epididymis and spermatic cord was observed on computed tomography and magnetic resonance imaging. Blood testing showed no abnormalities other than a minimal increase in C-reactive protein levels. Urine examination likewise revealed no significant findings. Left radical orchidectomy was performed under a diagnosis of left paratesticular neoplasm suspected as malignant tumor. The tumor was pathologically identified as IgG4-RD of the left paratestis involving the epididymis and spermatic cord. Conclusions We present a first description of IgG4-RD in a patient with Wells syndrome and the ninth case of IgG4-RD in a scrotal organ, and discuss this very rare entity with reference to the literature. Virtual Slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/13000_2014_225 [ABSTRACT FROM AUTHOR]

Background: Viliuisk encephalomyelitis (VE) is an endemic neurological disease in Northeast Siberia and generally considered to be a chronic encephalomyelitis of unknown origin actually spreading in the Sakha (Yakutian) Republic. Methodology and Principle Findings: In search for the pathophysiology and causative agent of VE, we performed a cross-sectional study on clinical, serological and neuroimaging data on chronic VE patients during two medical expeditions to three villages within the Viliuiski river basin in the Republic of Sakha in 2000 and to the capital Yakutsk in 2006. The severity of the core clinical picture with predominant sensory ataxia, gait apraxia, lower limb spasticity, cognitive impairment and bladder dysfunction correlated with the degree of MRI findings showing enlargement of inner ventricular spaces as in communicating hydrocephalus. Laboratory studies revealed transient eosinophilia during the preceding acute meningitis-like phase, but no ongoing inflammatory process in the CSF. We found immune reactions against Toxocara canis in the majority of chronic VE patients but rarely in controls (P = 0.025; Fisher's exact test). Histological analysis of subacute to subchronic VE brain samples showed eosinophilic infiltrations with no signs of persistent Toxocara canis infection. Conclusions and Significance: Our data showed that pressure by the communicating hydrocephalus as a mechanical factor is the major pathogenic mechanism in chronic VE, most likely triggered by eosinophilic meningitis. There are no signs for an ongoing inflammatory process in chronic VE. The past eosinophilic reaction in VE might be caused by Toxocara ssp. infection and might therefore represent the first hint for an initial cause leading to the development of chronic VE. Our data provide a framework for future studies and potential therapeutic interventions for this enigmatic epidemic neurological disease potentially spreading in Sakha Republic. [ABSTRACT FROM AUTHOR]

The "Wells syndrome" is a rare inflammatory dermatosis of unknown pathogenesis, clinical polymorph, both the location and the extent of the lesions. This is a skin disease of inflammatory origin, which usually appears in children and adolescents. Has a polymorphic clinical picture, both the location and the extent of the lesions, and for the correct interpretation of diagnostic histopathological lesions required. This entity should be considered in the differential diagnosis of any atypical presentation of cellulite with peripheral eosinophilia, that does not respond to antibiotics. [ABSTRACT FROM AUTHOR]

Background: Wells syndrome is an uncommon inflammatory dermatosis first described in 1971 by Wells. The clinical eruption is characterized by varying morphology and severity and usually follows a relapsing remitting course. The majority of the reported cases are of unknown etiology, drug induced Wells syndrome has rarely been reported. A literature search using MEDLINE was performed. We recorded the features of our case and of the additional cases of drug induced Wells syndrome in the literature. Main observations: Including our case there are 25 cases of drug-induced Wells syndrome reported. Causative drugs include antibiotics, anticholinergic agents, anaesthetics, non-steroidal anti-inflammatory agents, thyroid medications, chemotherapeutic agents, thiomersal containing vaccinations, anti-tumor necrosis factor agents and thiazide diuretics. Conclusions: To the authors knowledge this is the first reported case of drug-induced Wells syndrome from thiazide diuretics. The diagnosis of Wells syndrome is often controversial and we propose a set of diagnostic criteria. [ABSTRACT FROM AUTHOR]

Eosinophilic Cellulitis (Wells Syndrome) is an uncommon inflammatory disease with clinical polymorphism. A thirty-five-year-old female presented with 2 weeks history of gradually progressive and painful erythematous plaque on the right foot. She had already received several types of antibiotic for the cellulitis without improvement. A diagnosis of Wells syndrome was established. Significant improvement was noted after one month of treatment with prednisolone. Awareness of this condition is necessary for early identification and management. [ABSTRACT FROM AUTHOR]

Wells' syndrome (WS) is an uncommon inflammatory skin disease which typically presents single or multiple erythematous and edematous urticarial plaques similar to cellulitis. The lesions may evolve into blue-grey morphea-like lesions and may persist for weeks or months. They ultimately heal without scar. Other clinical presentations reported in literature include papular and nodular and, rarely, bullous eruptions. Previously, bullous Wells' syndrome was rarely reported in the literature. Herein, we describe a case of a female patient with bullous Wells' syndrome localized to the upper limbs without any associated disorders. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Well's syndrome is an uncommon condition of unknown etiology, clinically characterized by pruritic or tender cellulitis like eruption and histologically by flame figures in the dermis. We report a case of Well's syndrome in an 18-month-old boy who presented with urticaria like eruptions. [ABSTRACT FROM AUTHOR]

Eosinophilic cellulitis (Wells' syndrome) is an uncommon condition of unknown etiology. Wells' syndrome is usually seen in adulthood but very rare in childhood. Although pathogenesis of the disease is not very clear, it is a hypersensitivity reaction developing against a variety of exogenous and endogenous antigenic stimuli. Paraphenylenediamine is a strong allergen frequently used as a temporary henna tattoo, which makes the color darker . Here, a 9-year-old male patient with Wells' syndrome is presented, which developed following a temporary henna tattoo and shown by the patch test sensitivity to paraphenylenediamine. [ABSTRACT FROM AUTHOR]

Wells syndrome or eosinophilic cellulitis is a rare condition, primarily a disease of adults. It is characterized by edematous and erythematous plaques with violaceous borders persisting for weeks. Here, we describe a rare case of Wells syndrome occurring in a 51-year-old diabetic lady associated with a dental abscess. She was admitted with complaints of recurrent episodes of raised skin lesions on the body for the last two years. Patient also gave history of toothache with swelling of gums on and off since the last 2 years A skin biopsy was done from a raised lesion on the back which was consistent with eosinophilic cellulitis The patient was put on prednisolone 40mg daily along with ranitidine, calcium and oral hypoglycemics. She underwent tooth extraction for recurrent dental abscesses in the dental OPD. Our patient had dental abscess, a known predisposing factor. The association with diabetes mellitus is another unique feature, rarely reported before. [ABSTRACT FROM AUTHOR]

Stings by honeybees are not uncommon and most cases cause pain but no significant medical problems. Some patients, however, have lethal complications such as acute anaphylactic shock. Cellulitis caused by honeybee sting is very rare and can be a late complication in some patients. We report a 45-year-old female patient who was stung by a honeybee, and whose right forearm showed progressive swelling with bullous formation after the sting. She was sent to our emergency department with the diagnosis of right hand cellulitis. After treatment with antibiotics for 5 days, the lesions showed no response. Then, systemic steroid was used and the lesion gradually resolved. Diagnosis of Wells'' syndrome was made according to clinical appearance, course and characteristic histopathological findings. [Copyright &y& Elsevier]

The article presents a case study of a 45-year-old man with a history of fever and erythema of the extremities, the presence of lymphocytes and eosinophils were detected. It notes the demonstration of blood neutrophilia and the increased C-reactive protein, the impact of coxsackievirus A6 infection, and diagnosis of the patient for Wells' syndrome.

The article focuses on Splendore–Hoeppli phenomenon. It includes information on eosinophilic material in Splendore–Hoeppli reaction, inflammatory reaction of histiocytes, epithelioid cells, and giant cells. It also offers information on topics including Well's syndrome, actinomycotic sulfur granules, and asteroid bodies in sarcoidosis.

The article describes the case of eosinophilic cellulitis (EC) in a 68-year-old man induced by administration of interferon (IFN)-Β. Immunohistochemical staining for p signal transducers and activator of transcription (pSTAT) and pSTAT6 for 3 cases of ordinary, idiopathic EC. It found that repeated local injection of IFN-Β may have generated matured dendritic cell (DC) at the injection site.

Introduction: Eosinophilic cellulitis (Wells' syndrome) is an inflammatory dermatitis that is often misdiagnosed as infectious cellulitis due to its similarity in presentation. Misdiagnosis leads to delay of correct treatment and inappropriate use of antibiotics., Methods: A case series of eosinophilic cellulitis and a literature review are presented., Results: Patients with Wells' syndrome may present with a variety of nonspecific symptoms, such as fever, arthralgia and malaise, as well as myriad cutaneous lesions with associated erythema, presenting as blisters, bullae, papules and/or nodules. Several treatment modalities have been used to treat eosinophilic cellulitis and have been met with variable success rates; these include systemic corticosteroids, topical corticosteroids and antihistamines, with success rates of 91.7%, 50% and 25%, respectively., Conclusions: A high degree of clinical suspicion must be exercised to diagnose this rare condition. Cellulitis with an atypical presentation or not responding to appropriate antibiotic treatment should trigger suspicion of Wells' syndrome. To date, the most successful treatment method is a short course of systemic corticosteroids.