Eosinophilic cellulitis secondary to occult strongyloidiasis, case report

Abstract

: Eosinophilic cellulitis (EC), also known as Wells syndrome, is a rare reactive inflammatory dermatosis which may masquerade as bacterial cellulitis. A 59-year-old gentleman who presented with an acute onset of pruritic rashes affecting the chest and abdomen, along with painful induration over bilateral lower limbs, in association with blistering on his right leg. He had peripheral blood eosinophilia ranging from 0.91 to 1.17×10 9 /L with no biochemical evidence of sepsis. Skin biopsy revealed dermal interstitial lymphocytic infiltration with numerous eosinophils at various stages of degranulation, along with flame figures. EC causing pseudo-cellulitis was suspected. Three fecal samples were unyielding for ova and cysts, but Strongyloides immunoglobulin G serology was positive. The diagnosis of EC secondary to occult strongyloidiasis was made and the patient was treated with oral anti-helminthics and topical steroids with all the skin lesions resolving within 4 days. To our knowledge, this association has never been hitherto reported. This case showcases the following instructive points to the internist, namely (I) the low threshold to consider pseudo-cellulitis in apparent “bilateral lower limb cellulitis”; (II) the awareness of the entity of EC and the need to evaluate for underlying etiologies that cause this reactive dermatoses, such as including occult helminthic infections; (III) the correct way to perform a thorough evaluation for, and optimal treatment of helminthiasis.