Skin

Lupus is an extremely heterogeneous disease that can affect multiple organs. Chronic cutaneous lupus erythematosus can be further sub-divided into discoid lupus erythematosus (DLE), tumid lupus, and lupus panniculitis. DLE may occur in the absence of systemic disease, or may occur in association with systemic lupus erythematosus (SLE). Interestingly, in this patient, a separate, simultaneous biopsy demonstrated eosinophilic cellulitis (Wells Syndrome). Although these represent distinct diagnoses, a common pathophysiology cannot be excluded in this case (see related content).

Sections show parakeratosis, and heavy perivascular lympho-histiocytic infiltrates, with plasma cells. The basement is thickened, and this can be highlighted by PAS. Hales colloidal iron stain shows mucin accumulation.

This slide shows H&E stain, see related content for colloidal iron and PAS stains.

Lupus is an extremely heterogeneous disease that can affect multiple organs. Chronic cutaneous lupus erythematosus can be further sub-divided into discoid lupus erythematosus (DLE), tumid lupus, and lupus panniculitis. DLE may occur in the absence of systemic disease, or may occur in association with systemic lupus erythematosus (SLE). Interestingly, in this patient, a separate, simultaneous biopsy demonstrated eosinophilic cellulitis (Wells Syndrome). Although these represent distinct diagnoses, a common pathophysiology cannot be excluded in this case (see related content).

Sections show parakeratosis, and heavy perivascular lympho-histiocytic infiltrates, with plasma cells. The basement is thickened, and this can be highlighted by PAS. Hales colloidal iron stain shows mucin accumulation.

This slide shows colloidal iron stain, see related content for H&E and PAS stains.

Lupus is an extremely heterogeneous disease that can affect multiple organs. Chronic cutaneous lupus erythematosus can be further sub-divided into discoid lupus erythematosus (DLE), tumid lupus, and lupus panniculitis. DLE may occur in the absence of systemic disease, or may occur in association with systemic lupus erythematosus (SLE). Interestingly, in this patient, a separate, simultaneous biopsy demonstrated eosinophilic cellulitis (Wells Syndrome). Although these represent distinct diagnoses, a common pathophysiology cannot be excluded in this case (see related content).

Sections show parakeratosis, and heavy perivascular lympho-histiocytic infiltrates, with plasma cells. The basement is thickened, and this can be highlighted by PAS. Hales colloidal iron stain shows mucin accumulation.

This slide shows PAS stain, see related content for H&E and colloidal iron stains.

Wells syndrome (eosinophilic cellulitis) is an uncommon condition, of unknown aetiology. One report describes a patient with non-Hodgkin’s lymphoma, who presented successively with Wells syndrome, leukocytoclastic vasculitis and Sweet syndrome (Consigny 2001 Ann Dermatol Venereol), suggesting at least a certain degree of overlap between these entities. It is usually sporadic, although some association may be present with arthropod bites, infections, autoimmune diseases and leukaemias. In this patient, another lesion was simultaneously biopsied, which was diagnosed as discoid lupus erythematosus (see related content). Although these represent distinct diagnoses, a common pathophysiology cannot be excluded in this case.

Sections show sparing of the epidermis, with perivascular lymphocytic infiltrates. Numerous eosinophils are seen throughout, rimming the fatty tissue in the subcutis. Occasional flame figures are also seen.

See Related Content for references:
1) Consigny, S., et al. Ann Dermatol Venereol. 2001 Mar;128(3 Pt 1):213-6