J. Chang, J. Read, L. Banney
Introduction: Eosinophilic cellulitis, also known as Wells’ Syndrome, is characterised by recurrent pruritic to painful erythematous plaques with eosinophilic response in the dermis that resolves over days or weeks. The aetiology of this condition is unknown and it can present with variable clinical morphology, which can often delay diagnosis. Known precipitating factors include arthropod bites, infec- tion, malignancy, medications, or metals.
Case Presentation: A 66-year-old female presented with suspected cellulitis at the site of a spider bite to her right hand, and she subsequently developed indurated erythe- matous plaques to her left hand following midge ﬂy bites. Similar plaques developed on her proximal thighs without associated bites. Clinically the lesions were suspicious for urticarial vasculitis. Punch biopsy showed dermal oedema with inﬂammatory inﬁltrate composed of numerous eosi- nophils, neutrophils, and histiocytes in the superﬁcial and deep dermis. No ﬂame ﬁgures were seen. A diagnosis eosi- nophilic cellulitis secondary to arthropod bite was made, with associated Id reaction of skin distant to the bites.
Discussion: This case is an example of the variable pre- sentation of eosinophilic cellulitis, and that a simple punch biopsy is an invaluable tool in achieving the correct diag- nosis. Another learning point this case provides is the his- tological differences between eosinophilic cellulitis, urticarial vasculitis, and arthropod bite reaction, which are outlined in this poster.