Bullous eosinophilic cellulitis associated with giardiasis

Abstract

Conflict of interest: none declared. A 44‐year‐old man presented with a 10‐day history of a bilateral blistering eruption on both lower legs. There was no history of foreign travel, insect bites or asthma, and the patient had no gastrointestinal symptoms. On physical examination, tense bullae with circumferential erythema were seen on both lower legs (Fig. 1). The patient was otherwise systemically well and apyrexial. Initial laboratory investigations showed the patient to have a C‐reactive protein level of 22 mg/L (normal < 10 mg/L) and peripheral eosinophilia of 3.7 × 109/L; (normal range 0.04–0.4 × 109/L). The initial differential diagnosis included bullous pemphigoid, eosinophilic cellulitis and Churg–Strauss syndrome. A skin biopsy was taken, and while awaiting results the patient was treated with a potent topical corticosteroid and oral prednisolone 20 mg. On histological examination of the skin biopsy, superficial dermal oedema, red‐cell extravasation and inflammation were seen (Fig. 2a). The inflammation was interstitial, perivascular, superficial, and deep, and was composed of eosinophils and neutrophils (Fig. 2b). No vasculitis was seen. Immunofluorescence studies were negative for IgA, IgM, IgG and C3. A diagnosis of eosinophilic cellulitis (EC) was made.