Abstract
Dear Sir,
A 34-year-old female health care assistant presented with a 1 week history of gradual onset of swelling and redness of her right hand. The patient gave a vague history of an insect bite on the flexor surface of her wrist.
She was afebrile. There was gross global swelling of the whole of her right hand with mild erythema (Fig 1). There were no signs of any injury or insect bite marks. Palpation revealed local warmth and mild tenderness over the whole hand. There were no signs suggestive of flexor sheath infection or compartment syndrome. Plain radiographs of the hand and blood tests were unremarkable.
Initial treatment with IV penicillin failed. A dermatological opinion was obtained and a skin biopsy was performed which revealed eosinophilic cellulitis. The hand settled rapidly on oral steroids and betamethasone ointment (Fig 2).
Eosinophilic cellulitis or Wells’ syndrome is a rare condition of unknown aetiology and pathogenesis (Wells, 1971; Wells and Smith, 1979). Drugs, insect bites, infectious diseases, mumps virus, varicella zoster virus (VZV), herpes simplex virus (HSV) type 2 and some intestinal parasites have been implicated as possible causes.
The features of eosinophilic cellulitis resemble acute bacterial cellulitis which may be preceded by pruritis or a burning sensation. There may be spreading eruptions which are rose coloured and have violaceous borders with clear central regions or at times bullae. Later they change into indolent, hard, morphea like lesions. The course may last from a few weeks to years. It is non-scarring but associated with hyperpigmentation of the skin. Recurrences are common. The histological findings are diagnostic.
Although Steirstorfer and Clendenning (1991) reported a case of eosinophilic cellulitis overlying a prosthetic hip replacement, eosinophilic cellulitis does not appear to have been reported in the hand. It should be considered when a ‘typical bacterial infection’ does not settle with appropriate treatment.