Wells’ syndrome in an 18-year-old Filipino female: a case report

Abstract

Introduction

Wells’ syndrome, also known as eosinophilic cellulitis, is a rare inflammatory dermatosis that mostly affects adults and manifests as recurrent erythematous papules, vesicles, and nodules. With predilection sites that may vary and clinical presentation that may mimic other cutaneous diseases, it can be misdiagnosed and eventually mismanaged. Hence, it is important for dermatologists to warrant the need to investigate further when faced with a recurrent dermatitis such as Wells’ syndrome.

Case Report

This is a case of an 18-year-old Filipino female with no known comorbidities, who presented with a three year history of recurrent erythematous papules, vesicles, and nodules over her bilateral side of the chin. She was initially managed as a case of infected acne vulgaris, and was given oral antibiotics such as Cloxacillin, Rifampicin, and Clarithromycin, but with minimal improvement. She was then referred to Dermatology service for further evaluation. A 3-mm skin punch biopsy on an erythematous nodule on the left chin was done, and histopathologic findings were diffuse eosinophilic infiltrates, exhibiting flame figures admixed with few lymphocytes and neutrophils, consistent with Wells’ syndrome, otherwise known as eosinophilic cellulitis. Serology also revealed elevated IgE level at 949.2 IU/mL but normal eosinophil count. Patient was then given oral corticosteroid for eight weeks, resulting in complete resolution of lesions and no residual scarring.

Conclusion

Wells’ syndrome is a rare dermatitis and it is usually misdiagnosed with other more common cutaneous diseases, most often than not with bacterial cellulitis. When confronted with a cutaneous lesion that is not responding to treatment, a dermatology referral is warranted. Various treatment modalities for Wells’ syndrome exist, such as systemic corticosteroids, systemic immunomodulators, and topical application of steroid or tacrolimus. Among the aforementioned treatment options, systemic corticosteroid is still considered the first-line therapy because it provides good therapeutic response and complete clearance of skin lesions.