Wells syndrome (eosinophilic cellulitis). A retrospective study in 35 adult patients

Tirado‐Sánchez, Andrés; Sánchez-Álvarez, Israel; Bonifáz, Alexandro

doi:10.1016/j.medcli.2021.01.026

Cited by 1 publication

(2 citation statements)

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“…Wells as "recurrent granulomatous dermatitis with eosinophilia" [55], WS is a rare dermatosis without ethnic or gender predilection that primarily affects adults [56]. The etiology is unknown, although some cases have been associated with various underlying conditions and triggers, including hematologic disorders [20,[57][58][59][60][61][62][63][64][65], hypersensitivity reaction to insect bites [40,66,67], medications [68][69][70], infections [71][72][73], and vaccinations [56,[74][75][76]. Peripheral eosinophilia, leukocytosis, or elevated inflammatory markers may be observed [58,77].…”

Section: Discussionmentioning

confidence: 99%

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Eosinophilic Dermatosis of Hematologic Malignancy: Emerging Evidence for the Role of Insect Bites—A Retrospective Clinico-Pathological Study of 35 Cases

Michelerio,

Rubatto,

Roccuzzo

et al. 2024

JCM

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Background/Objectives: Eosinophilic dermatosis of hematologic malignancy (EDHM) is a rare cutaneous disorder associated with various hematologic malignancies, most commonly chronic lymphocytic leukemia. Detailed clinicopathologic studies of EDHM are lacking and the pathogenesis remains enigmatic. Initially thought to be a hypersensitivity reaction to insect stings, subsequent reports have challenged this understanding. The prognostic implications of EDHM remain unclear. Methods: A retrospective clinicopathologic study was performed on patients diagnosed with EDHM. Hematologic and dermatologic data were reviewed. Histologic specimens were re-evaluated and lesions were classified into acute/subacute, fully developed, and chronic/regressing. Results: The study included 35 patients. In 80% of these patients, EDHM was diagnosed after the hematologic disorder. Approximately 45% of the cohort experienced hematologic disease progression or relapse, while 65% required therapeutic intervention during the course of their hematologic disease. In total, 15/19 CLL patients had non-mutated IgHV, a marker of a more aggressive hematologic disease course. Dermatologic lesion morphology was heterogeneous, with most lesions occurring on exposed areas, and a significant 94% of patients demonstrated lesion seasonality. Histopathologic findings were consistent with features typically associated with insect bites. In addition, examination of lesions at different chronological stages revealed substantial similarities with Wells syndrome. Conclusions: Our findings support the potential role of insect bites in triggering EDHM in the context of adaptive immune dysfunction. EDHM may be associated with a more aggressive disease course or may be a marker of disease progression. The observed co-occurrence of features typical of Wells syndrome in EDHM patients suggests that these conditions are part of a spectrum of disorders that vary in clinical expression.

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Section: Discussionmentioning

confidence: 99%

“…Furthermore, bites or stings from arthropods such as mosquitoes, fleas, honeybees, ticks, spiders, and even centipedes have been reported as potential triggers of WS [38,40,59,66,67,83]. Similarly, hematologic malignancies have been mentioned as potential initiators of WS [20,[56][57][58][59][60][61][62][63][64][65]84].…”

Section: Discussionmentioning

confidence: 99%