Serpiginous Purpuric Eruption of the Leg.

TitleSerpiginous Purpuric Eruption of the Leg.
Publication TypeJournal Article
Year of Publication2017
AuthorsTotoraitis K, Magro CM, Friedman A
JournalJ Drugs Dermatol
Volume16
Issue10
Pagination1036-1038
Date Published2017 Oct 01
ISSN1545-9616
KeywordsAged, 80 and over, Biopsy, Cellulitis, Eosinophilia, Humans, Hypersensitivity, Delayed, Male, Purpura, Skin, Th2 Cells
Abstract

A previously healthy 68-year-old male presented with a rash on his right lower leg. The lesions had spread along the leg since onset 9 days prior, and the patient reported localized soreness and pruritus. He denied systemic symptoms including fever, fatigue, myalgia, joint pain, and recent illness. Physical examination revealed a serpiginous, purpuric eruption on the anterior and posterior right thigh and lower leg. A 4mm punch biopsy from the right lower leg revealed a Th2 dominant process reflective of a type IV delayed hypersensitivity reaction. Superficial and deep angiocentric and eccrinotropic lymphocytic infiltrate and tissue eosinophilia were noted. Degranulated eosinophils forming 'flame figures' were also identified with accompanying mural edema and red blood cell extravasation. Further evaluation revealed an elevated antistreptolysin O antibody, though the remainder of the work up was unremarkable. Clinicohistopathologic correlation supported the diagnosis of Blaschkolinear purpuric Wells' Syndrome. This case highlights a unique presentation of a rare inflammatory dermatosis, and serves as a reminder that given Wells' can be associated with underlying malignancy, an age appropriate work up, based on patient history and presentation, may be warranted.

J Drugs Dermatol. 2017;16(10):1036-1038.

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Alternate JournalJ Drugs Dermatol
PubMed ID29036258
Related Faculty: 
Cynthia M. Magro, M.D.

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