[Wells syndrome misdiagnosed as bacterial cellulitis]. 2020

F Kettani, and K Baline, and F Hali, and S Azzouzi, and S Chiheb
Service de dermatologie et vénéréologie, CHU de Ibn Rochd, Casablanca, Maroc. Electronic address: kettani.fatimazohra@gmail.com.

Wells syndrome (WS), also called eosinophilic cellulitis is a rare inflammatory skin disease with about 200 cases reports in the literature. It is part of eosinophilic dermatoses and presents a diagnostic challenge. We report a case of WS presenting as bacterial cellulitis. A 59 year-old woman was referred to our department with a 10-day history of a rapidly extending erysipelatoid rash of the left upper limb, non-responding to oral antibiotics. Upon physical examination, erythema with swelling and blisters were found on the left upper limb with urticarial-like lesions on the breast, the belly and on the inner thighs. The patient was admitted with presumed bacterial cellulitis and was treated with intravenous ampicillin. Blood count showed raised eosinophils (2050/ul) along with a biological inflammatory syndrome. Biopsies were performed on both bullous and urticarial-like lesions showing perivascular and interstitial inflammatory infiltrate, made essentially of eosinophils with flame figures. The diagnosis of WS was made and the patient received local and oral corticosteroids (0,5mg/kg/d) with good evolution. The rarity and clinical manifestations of WS makes it sometimes difficult to differentiate between a WS and a bacterial cellulitis. However, biological and histological findings can help the clinician make the differential diagnosis between these two diseases for a better management.

UI MeSH Term Description Entries
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D002481 Cellulitis An acute, diffuse, and suppurative inflammation of loose connective tissue, particularly the deep subcutaneous tissues, and sometimes muscle, which is most commonly seen as a result of infection of a wound, ulcer, or other skin lesions. Phlegmon
D003937 Diagnosis, Differential Determination of which one of two or more diseases or conditions a patient is suffering from by systematically comparing and contrasting results of diagnostic measures. Diagnoses, Differential,Differential Diagnoses,Differential Diagnosis
D003951 Diagnostic Errors Incorrect or incomplete diagnoses following clinical or technical diagnostic procedures. Diagnostic Blind Spots,Errors, Diagnostic,Misdiagnosis,Blind Spot, Diagnostic,Blind Spots, Diagnostic,Diagnostic Blind Spot,Diagnostic Error,Error, Diagnostic,Misdiagnoses
D004802 Eosinophilia Abnormal increase of EOSINOPHILS in the blood, tissues or organs. Eosinophilia, Tropical,Hypereosinophilia,Tropical Eosinophilia,Hypereosinophilias,Tropical Eosinophilias
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000305 Adrenal Cortex Hormones HORMONES produced by the ADRENAL CORTEX, including both steroid and peptide hormones. The major hormones produced are HYDROCORTISONE and ALDOSTERONE. Adrenal Cortex Hormone,Corticoid,Corticoids,Corticosteroid,Corticosteroids,Cortex Hormone, Adrenal,Hormone, Adrenal Cortex,Hormones, Adrenal Cortex
D012872 Skin Diseases, Vesiculobullous Skin diseases characterized by local or general distributions of blisters. They are classified according to the site and mode of blister formation. Lesions can appear spontaneously or be precipitated by infection, trauma, or sunlight. Etiologies include immunologic and genetic factors. (From Scientific American Medicine, 1990) Bullous Skin Diseases,Pustular Dermatosis, Subcorneal,Skin Diseases, Bullous,Skin Diseases, Vesicular,Sneddon-Wilkinson Disease,Subcorneal Pustular Dermatosis,Vesicular Skin Diseases,Vesiculobullous Skin Diseases,Bullous Dermatoses,Vesiculobullous Dermatoses,Bullous Skin Disease,Dermatoses, Bullous,Dermatoses, Subcorneal Pustular,Dermatoses, Vesiculobullous,Dermatosis, Subcorneal Pustular,Pustular Dermatoses, Subcorneal,Skin Disease, Bullous,Skin Disease, Vesicular,Skin Disease, Vesiculobullous,Sneddon Wilkinson Disease,Subcorneal Pustular Dermatoses,Vesicular Skin Disease,Vesiculobullous Skin Disease
D017192 Skin Diseases, Bacterial Skin diseases caused by bacteria. Bacterial Skin Diseases,Bacterial Skin Disease,Disease, Bacterial Skin,Skin Disease, Bacterial

Related Publications

F Kettani, and K Baline, and F Hali, and S Azzouzi, and S Chiheb
June 2011, Emergency medicine Australasia : EMA,
F Kettani, and K Baline, and F Hali, and S Azzouzi, and S Chiheb
July 2011, The Journal of clinical and aesthetic dermatology,
F Kettani, and K Baline, and F Hali, and S Azzouzi, and S Chiheb
August 2015, Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases,
F Kettani, and K Baline, and F Hali, and S Azzouzi, and S Chiheb
January 2022, Ophthalmic plastic and reconstructive surgery,
F Kettani, and K Baline, and F Hali, and S Azzouzi, and S Chiheb
June 1992, International journal of dermatology,
F Kettani, and K Baline, and F Hali, and S Azzouzi, and S Chiheb
March 1985, International journal of dermatology,
F Kettani, and K Baline, and F Hali, and S Azzouzi, and S Chiheb
January 1990, Medicina cutanea ibero-latino-americana,
F Kettani, and K Baline, and F Hali, and S Azzouzi, and S Chiheb
August 2001, Nederlands tijdschrift voor geneeskunde,
F Kettani, and K Baline, and F Hali, and S Azzouzi, and S Chiheb
March 2000, Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete,
F Kettani, and K Baline, and F Hali, and S Azzouzi, and S Chiheb
September 1990, Giornale italiano di dermatologia e venereologia : organo ufficiale, Societa italiana di dermatologia e sifilografia,
Copied contents to your clipboard!