case_images: PMC11833746_01
case_images: Early flare of eosinophilic cellulitis with orange-pink edema expanding from the fifth digit of the left foot.
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case_images: PMC11833746_01_gr1.jpg
case_images: fig1
case_images: However, several weeks later, the patient experienced an acute episode of left foot erythema, edema, and pain (Fig 1) concerning for cellulitis, for which she was admitted to the hospital for intravenous antibiotics after worsening on oral antibiotics.
case_images: Site marked for punch biopsies at the edge of bullae, area is blanched from injection of lidocaine with epinephrine.
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case_images: PMC11833746_01_gr2.jpg
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case_images: She improved and was discharged, but several weeks later the same area developed another erythematous, nonpurulent bulla with pruritus (Fig 2), at which point blood work, wound culture, and skin biopsies were obtained.
case_images: A, There is a brisk inflammatory infiltrate with many eosinophils involving the papillary and reticular dermis and extending into the subcutaneous adipose tissue. The roof of the blister is detached and not present in this image. B, The infiltrate is composed of numerous eosinophils admixed with lymphocytes and histiocytes. C, D, On high power there are multiple areas with eosinophils degranulating. (A-D, Hematoxylin-eosin stain; original magnifications: A, x20; B, x200; C and D, x400.)
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case_images: PMC11833746_01_gr3.jpg
case_images: fig3
case_images: Punch biopsy of the left medial fifth toe revealed papillary and reticular perivascular dermatitis with numerous eosinophils and a subepidermal blister (Fig 3, A, B).