Eosinophilic Dermatosis of Hematological Malignancy Mimicking Wells Syndrome

Case Report

Austin J Dermatolog. 2022; 9(1): 1100.

Eosinophilic Dermatosis of Hematological Malignancy Mimicking Wells Syndrome

Shah MA¹, Khamdan FA²*, Khamdan MA² and Alkhayyat RMH³

¹School of Medicine, University of South Carolina, Columbia, SC, USA

²Department of Dermatology, Salmanyia Medical Complex, Kingdom of Bahrain

³Department of Pathology, Salmanyia Medical Complex, Kingdom of Bahrain

*Corresponding author: Fatema A Khamdan, Department of Dermatology, Salmanyia Medical Complex, P.O Box 12, Kingdom of Bahrain

Received: December 03, 2021; Accepted: December 29, 2021; Published: January 05, 2022

Abstract

Wells syndrome, also known as eosinophilic cellulitis, is an inflammatory dermatitis that is often misdiagnosed as infectious cellulitis, leading to the inappropriate use of antibiotics and a delay appropriate treatment. We present a diagnostically challenging case where a 65-year-old male with a known case of SLL was found to have eosinophilic dermatosis of hematological malignancy after a thorough workup. Although the association between CLL and Wells syndrome is well established, we have not encountered any similar association or other cases of Wells syndrome associated with SLL in the literature. The pathophysiology underlying the association between eosinophilic cellulitis and CLL/SLL remains incompletely understood, and further investigation is warranted.

Keywords: Wells Syndrome; Small Lymphocytic Lymphoma; Eosinophilic Dermatosis of Hematological Malignancy; Eosinophilic Cellulitis

Introduction

Wells syndrome, also known as eosinophilic cellulitis, is an inflammatory dermatitis that typically presents with erythematous plaques, although the presentation can vary significantly. Eosinophilic cellulitis, as the name implies, can present similarly to erysipelas/cellulitis and is often misdiagnosed as infectious cellulitis [1]. Early accurate identification is key, as misdiagnosis can lead to the inappropriate use of antibiotics and delay appropriate treatment. Thus, we present a case of a 65-year-old male with a known case of small lymphocytic lymphoma (SLL) who developed eosinophilic dermatosis of hematological malignancy (EDHM).

Case Presentation

A 65-year-old Bahraini male with a known case of small lymphocytic lymphoma (SLL) since 2015, which was being followed by hematology, presented to the accident and emergency in May 2020 with one week of itchy skin lesions on his face and arm and swelling of the foot. He also reported that over the last year, he has had on/ off lesions of similar character distributed diffusely on his body associated with swelling of the limbs. He was initially believed to have an insect bite with cellulitis and was prescribed several courses of antibiotics, although he denied any recollection of a preceding insect bite. After resistance to antibiotic treatment, he had a skin biopsy and was then incorrectly diagnosed as having a drug reaction. On physical examination, the patient was well-appearing and a febrile. He had an erythematous plaque with multiple small pustules in the periphery on his forehead. In addition, there were multiple erythematous violaceous papules, nodules, and plaques on his elbow, left leg and right foot with significant swelling, redness and change in the temperature (Figure 1A-1D). The initial differential diagnosis included: wells syndrome, erythema elevatum diutinum, sweet syndrome, and leukemia cutis.

Citation: Shah MA, Khamdan FA, Khamdan MA and Alkhayyat RMH. Eosinophilic Dermatosis of Hematological Malignancy Mimicking Wells Syndrome. Austin J Dermatolog. 2022; 9(1): 1100.