Article: Clinical Entity Mimicking Infectious Cellulitis: Eosinophilic Cellulitis (Wells' Syndrome)

Eosinophilic cellulitis (EC) is a skin disease characterized by pruritic, non-purulent, erythematous plaques and histologically by edema and eosinophil infiltration in the dermis. The etiopathogenesis of the disease is not fully elucidated. It differs from infectious cellulitis by being unresponsive to antibiotics and recurring. This case report presents a late-diagnosed case of EC in a patient who did not respond to long-term and broad-spectrum antibiotics. This case underscores the importance of skin biopsy and histopathological diagnosis in patients with recurrent, non-responsive, antibiotic-resistant, and cellulitis-like clinical features resembling infectious cellulitis; "eosinophilic cellulitis" should be considered in the differential diagnosis.

Citing Articles

Localized eosinophilic cellulitis treated with topical ruxolitinib: A case report.

Monroe J, St Pierre A, Hernandez A, Singer H JAAD Case Rep. 2025; 57:34-37.

PMID: 39968024 PMC: 11833746. DOI: 10.1016/j.jdcr.2024.12.020.

References

1.

WELLS G, Smith N . Eosinophilic cellulitis. Br J Dermatol. 1979; 100(1):101-9. DOI: 10.1111/j.1365-2133.1979.tb03574.x. View

2.

Haddad F, Helm T . Wells syndrome. Cutis. 2014; 93(1):17, 38-9. View

3.

Heelan K, Ryan J, Shear N, Egan C . Wells syndrome (eosinophilic cellulitis): Proposed diagnostic criteria and a literature review of the drug-induced variant. J Dermatol Case Rep. 2014; 7(4):113-20. PMC: 3888780. DOI: 10.3315/jdcr.2013.1157. View

4.

Heinig B, Vojvocic A, Lotti T, Tirant M, Wollina U . Wells Syndrome - An Odyssey. Open Access Maced J Med Sci. 2019; 7(18):3002-3005. PMC: 6910816. DOI: 10.3889/oamjms.2019.572. View

5.

Gallard C, Law-Ping-Man S, Darrieux L, Tisseau L, Safa G . [Wells syndrome mimicking facial cellulitis: Three cases]. Ann Dermatol Venereol. 2016; 144(4):284-289. DOI: 10.1016/j.annder.2016.09.676. View

6.

Sinno H, Lacroix J, Lee J, Izadpanah A, Borsuk R, Watters K . Diagnosis and management of eosinophilic cellulitis (Wells' syndrome): A case series and literature review. Can J Plast Surg. 2013; 20(2):91-7. PMC: 3383552. DOI: 10.1177/229255031202000204. View

7.

Rozenblat M, Cohen-Barak E, Dodiuk-Gad R, Ziv M . Wells' Syndrome Induced by Ustekinumab. Isr Med Assoc J. 2019; 21(1):65. View

8.

Seckin D, Demirhan B . Drugs and Wells' syndrome: a possible causal relationship?. Int J Dermatol. 2001; 40(2):138-40. View

9.

Ludwig R, Grundmann-Kollmann M, Holtmeier W, Wolter M, Glas J, Podda M . Herpes simplex virus type 2-associated eosinophilic cellulitis (Wells' syndrome). J Am Acad Dermatol. 2003; 48(5 Suppl):S60-1. DOI: 10.1067/mjd.2003.20. View

10.

Rajpara A, Liolios A, Fraga G, Blackmon J . Recurrent paraneoplastic wells syndrome in a patient with metastatic renal cell cancer. Dermatol Online J. 2014; 20(6). View

11.

Caputo R, Marzano A, Vezzoli P, Lunardon L . Wells syndrome in adults and children: a report of 19 cases. Arch Dermatol. 2006; 142(9):1157-61. DOI: 10.1001/archderm.142.9.1157. View

12.

Pessach I, Petevi K, Gkirkas K, Stamouli M, Constantinou P, Rontogianni D . Wells' syndrome with a clinicopathological correlation associated with mantle-cell lymphoma. Leuk Lymphoma. 2016; 57(11):2702-4. DOI: 10.3109/10428194.2016.1157876. View