Eosinophilic cellulitis is a rare dermatosis first described by Wells, and characterized by recurrent episodes of sudden outbreaks of erythematous cutaneous swellings often painful or pruritic. Microscopically, the lesion shows diffuse tissue eosinophilia and fibrinoid flame figures, evolution of associated focal necrobiosis, and formation of focal microgranulomas associated with eosinophils. The cause is still unknown but the triggers which have been thought to precipitate the disease include insect bites, parasitic infections such as toxocara, onchocerciasis, nasopharyngeal carcinoma, rheumatoid arthritis and spider bites. However many cases are idiopathic. The author experienced a case of eosinophilic cellulitis of a 52-year-old woman with multiple cutaneous tender plaques of cellulitis for approximately 10 years with history of repeated remission and recurrent episodes. Biopsy was taken from ulcerated edematous nodule of inguinal region under the clinical impression of deep fungal infection, pyoderma gangrenosum and polyarteritis nodosa. Cultures for fungal and common organisms were negative. Histologically, the entire dermis was infiltrated by numerous eosinophils and scattered histiocytes. There were scattered flame figures showing necrobiotic foci in the collagen with accumulation of eosinophils, granulated free cosinophilic granules and histiocytes.
Biopsy ; Cellulitis/pathology* ; Cellulitis/therapy ; Eosinophilia/pathology* ; Eosinophilia/therapy ; Female ; Humans ; Middle Aged

Eosinophilic cellulitis is a rare dermatosis first described by Wells, and characterized by recurrent episodes of sudden outbreaks of erythematous cutaneous swellings often painful or pruritic. Microscopically, the lesion shows diffuse tissue eosinophilia and fibrinoid flame figures, evolution of associated focal necrobiosis, and formation of focal microgranulomas associated with eosinophils. The cause is still unknown but the triggers which have been thought to precipitate the disease include insect bites, parasitic infections such as toxocara, onchocerciasis, nasopharyngeal carcinoma, rheumatoid arthritis and spider bites. However many cases are idiopathic. The author experienced a case of eosinophilic cellulitis of a 52-year-old woman with multiple cutaneous tender plaques of cellulitis for approximately 10 years with history of repeated remission and recurrent episodes. Biopsy was taken from ulcerated edematous nodule of inguinal region under the clinical impression of deep fungal infection, pyoderma gangrenosum and polyarteritis nodosa. Cultures for fungal and common organisms were negative. Histologically, the entire dermis was infiltrated by numerous eosinophils and scattered histiocytes. There were scattered flame figures showing necrobiotic foci in the collagen with accumulation of eosinophils, granulated free cosinophilic granules and histiocytes.
Biopsy ; Cellulitis/pathology* ; Cellulitis/therapy ; Eosinophilia/pathology* ; Eosinophilia/therapy ; Female ; Humans ; Middle Aged

Abscess ; microbiology ; therapy ; Cellulitis ; Humans ; Nasal Septum ; microbiology

A 12-year-old boy showed a slatecolored scaly patch on h; ight face for 2 months. Histopathologic findings showed basal vacuolations and dermal me arphages with only scanty lymphoid cells in the fat tissue layer. Besides the facial lesion, lesions of edematous localized erythema were noted on his right if and left buttock with similar mi rocopical findings. 6 months later the facial lesion was aggravated like a cellulitis, of which thc bevpsy findings were consistent with mycosis fungoides. The patient received chemotherapy aftei the diagonsis for one month before his termination. Because of the rarity of mycosis fungoides in childhood age and its un common cutaneous lesions, the case is reported.
Buttocks ; Cellulitis ; Child ; Dronabinol ; Drug Therapy ; Erythema ; Humans ; Lymphocytes ; Male ; Mycosis Fungoides* ; United Nations

Objective: To review the clinical characteristics, to illustrate diagnosis and management experience of orbital and cranial complications of pediatric acute rhinosinusitis. Methods: The clinical data of 24 children with orbital and cranial complications of acute rhinosinusitis who received endoscopic sinus surgery combined with drug treatment in Beijing Children's Hospital from January 2017 to December 2021 were retrospectively reviewed. There were 19 boys and 5 girls. The age varied from 13 to 159 months, with a median 47.5 months. The following diagnoses were obtained: 12 isolated subperiosteal orbital abscess, 2 associated with preseptal abscess, 2 associated with intraorbital abscess, 7 associated with optic neuritis, and 1 associated with septic cavernous sinus thrombosis. Clinical characteristics, organism isolated and outcomes were analyzed through descriptive methods. Results: All 24 patients presented with fever; 9 presented with nasal congestion and purulent discharge. The clinical manifestations of orbital infection included orbital edema, pain, proptosis and displacement of globe in all patients, while visual impairment was recognized in 7 children. Purulent drainage was cultured in 17 patients, among which 12 were positive. All patients underwent nasal endoscopic surgical interventions uneventfully, excluding one patient who required a second surgical procedure. Follow-up period ranged from 5 to 64 months. All patients resolved fully, with the exception of 2 children who got permanent blindness with visual loss preoperative. There was no recurrence or death. Conclusions: Orbital and cranial complications of pediatric acute rhinosinusitis could be severe with an occult onset. For patients with vison impairment, any signs of intracranial complications and a lack of response to conservative management, an urgent endoscopic intervention is needed.
Male ; Female ; Child ; Humans ; Abscess/therapy* ; Retrospective Studies ; Sinusitis/therapy* ; Orbital Cellulitis ; Acute Disease ; Exophthalmos ; Orbital Diseases/therapy*

Eosinophilic cellulitis (Wells'syndrome) is an uncommon skin disorder. We report two adult male patients who had recurrent erythematous plaques and a nodular lesion on the abdomen. The histopathologic feature of their skin biopsies similarly indicated a marked infiltrate of eosinophils in the dermis with the fashion of "flame figures". One of the patients demonstrated blood eosinophilia. Given the clinicohistological findings, the patients fulfilled the criteria for the diagnosis of eosinophilic cellulitis. The skin lesions remained refractory to medications such as corticosteroids, sulfones, antihistamines, and minocycline. Considering the beneficial effect of cyclosporine in the treatment of eosinophilia-associated dermatoses, we speculated that eosinophilic cellulitis might respond to cyclosporine therapy. Thus, each of the two patients was given cyclosporine (microemulsion formulation) at a daily dose of 1.25 or 2.5 mg/kg, i.e., 100 or 200 mg, respectively. Complete remission of the skin eruptions was obtained in both patients during a 3- or 4-week period of treatment. No side effects were observed. Neither of the patients experienced relapse of the disease at least over 10 months after the discontinuation of the cyclosporine therapy. We suggest that administration of low-dose cyclosporine be a safe and useful therapeutic option in patients with eosinophilic cellulitis.
Adult ; Case Report ; Cellulitis/*drug therapy ; Cyclosporine/*therapeutic use ; Eosinophilia/*drug therapy ; Human ; Immunosuppressive Agents/*therapeutic use ; Male

Wells' syndrome or eosinophilic cellulitis is an uncommon cutaneous disorder characterized by recurrent erythematous and edematous plaques that often resemble acute cellulitis. The characteristic microscopic findings are diffuse dermal eosinophilia with marked edema, and flame figures consisting of amorphous or granular eosinophilic material around collagen bundles of the dermis. Etiology and pathogenesis are unknown, but the disease has been found to be associated with infections, arthropod bites, drug administration, surgery and hematologic disorders. We report the case of a 55-year-old man with pancreatic carcinoma who was presented with an asymptomatic erythematous to brownish subcutaneous nodule on the left buttock of several days' duration. A biopsy specimen taken from the erythematous to brownish nodule showed many flame figures and diffuse infiltration of eosinophils in the dermis and subcutaneous fat tissue. The rapid resolution of the skin lesion with chemotherapy of the pancreatic carcinoma supports a relationship between the two conditions.
Arthropods ; Biopsy ; Buttocks ; Cellulitis ; Collagen ; Dermis ; Drug Therapy ; Edema ; Eosinophilia ; Eosinophils ; Humans ; Middle Aged ; Skin ; Subcutaneous Fat

Serratia marcescens is a gram-negative bacillus of enterobacteriaceae family. The organism is known to cause various types of infection including cellulitis, bacteremia, pneumonia, endocarditis, meningitis, peritonitis, osteomyelitis, and septic arthritis. Cellulitis due to gram-negative organisms is uncommon and usually occurs in immunosuppressed hosts. We present a case of S. marcescens cellulitis in a patient with acute lymphocytic leukemia who had been treated with chemotherapy. Microbial studies with pus identified S. marcescens as a causative organism of cellulitis. The lesion healed completely by antibiotic treatment.
Arthritis, Infectious ; Bacillus ; Bacteremia ; Cellulitis* ; Drug Therapy ; Endocarditis ; Enterobacteriaceae ; Humans ; Immunocompromised Host ; Leukemia ; Meningitis ; Osteomyelitis ; Peritonitis ; Pneumonia ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Serratia marcescens* ; Serratia* ; Suppuration

Clinical chemotherapy refractoriness is characterized by resistance to multiple drugs. Multidrug resistance(MDR) is caused by over-reactivity of a unidirectional drug efflux pump, transmembrane glycoprotein(P-glycoprotein), which is encoded by the MDR1 gene. P-glycoprotein leads to increased drug efflux and decreased intracellular drug concentration. Clinical trials that attempt to reverse or modulate MDR have been done. Cyclosporin-A and verapamil are the most extensively studied agents and several trials of cyclosporin-A as a MDR modulator have been reported. We report a case of an 8-year-old girl with acute mixed type leukemia who failed to respond 3 times to remission-induction therapy. It led us to conclude she had multidrug resistance. We tried a fourth induction chemotherapy including cytarabine, idarubicin and 6-thioguanine to which cyclosporin-A was added. Then, she showed signs of severe bone marrow depression and fulminant perianal cellulitis. But she recovered and successfully achieved complete remission. The addition of cyclosporine could be useful in achieving complete remission for cases of acute leukemia that resist to usual chemotherapy. Futher observation including more cases will be needed to assess long-term survival and efficacy of adding cyclosporine.
Bone Marrow ; Cellulitis ; Child ; Cyclosporine ; Cytarabine ; Depression ; Drug Resistance ; Drug Resistance, Multiple ; Drug Therapy ; Female ; Humans ; Idarubicin ; Induction Chemotherapy ; Leukemia* ; P-Glycoprotein ; Thioguanine ; Verapamil

Damages to the sensory, autonomic and motor nerves in leprosy patients are followed by anesthesia, dryness of the skin and muscular paralysis. Most plantar ulcers in leprosy patients are caused by repetitive moderate stress. Minor injuries such as bruising sustained as a result of the misuse of anesthetic limbs may lead to ulceration, scar formation and secondary infection. Cellulitis develops and destroys subcutaneous tissue, resulting in an infection which can reach the bone. As a result of osteomyelitis, bone is absorbed, sequestra are extruded and the architecture of the foot is destructed. The most common sites of the plantar ulceration are over the metatarsal heads, the base of the fifth metatarsal, the base of the proximal phalanx, and the calcaneus. During the past 9 years, we treated 85 patients with ulcers located on the sole and the dorsum of the foot, and lower third of the leg. To prevent osteomyelitis and amputation of the lower leg, we performed various treatment modalities such as free and pedicle flaps, skin grafts, and mechanical stretching devices of the skin (e.g., Sure Closure, Proxiderm, etc), as well as consistent vacuum-assisted closure. We obtained satisfactory results in most cases. We report detailed results and related references.
Amputation ; Anesthesia ; Calcaneus ; Cellulitis ; Cicatrix ; Coinfection ; Extremities ; Foot Ulcer* ; Foot* ; Head ; Humans ; Leg ; Leprosy* ; Metatarsal Bones ; Negative-Pressure Wound Therapy ; Osteomyelitis ; Paralysis ; Skin ; Subcutaneous Tissue ; Transplants ; Ulcer