Rajpara Anand, Liolios Ana, Fraga Garth, Blackmon Joseph
University of Kansas Medical Center.
Dermatol Online J. 2014 Jun 15;20(6):13030/qt35w8r1g3.
A 58-year-old man with a history of hyperlipidemia and hypertension presented to the dermatology clinic with a 3-month history of a sudden onset, progressively worsening pruritic eruption involving the torso and extremities. Prior treatment included azithromycin and oral and intramuscular steroids, without improvement. Laboratory results demonstrated a serum eosinophil count of 7x10(3)/uL (normal 0-4). A 4-mm punch biopsy of the plaque on the patient's left thigh revealed a diffuse dermatitis with innumerable eosinophils with formation of "flame figures." Histologically, these findings are consistent with a diagnosis of Wells syndrome (WS). A work up for possible underlying malignancy found that the patient had underlying clear cell renal carcinoma. The eruption largely resolved following right laparoscopic nephrectomy with negative surgical margins, thus confirming the diagnosis of paraneoplastic WS. However, 2 years later the patient developed metastasis to his liver, lungs, and ribs. The patient's cancer has continued to progress despite treatment with high-dose interleukin-2, oral sunitinib, afinitor. avastin, azacytidine, and currently axitinib. Our case is the first to describe eosinophilic cellulitis arising in a patient with underlying renal cell carcinoma.
一名58岁男性，有高脂血症和高血压病史，因突发、进行性加重的瘙痒性皮疹3个月就诊于皮肤科门诊，皮疹累及躯干和四肢。先前的治疗包括阿奇霉素以及口服和肌肉注射类固醇，但均无改善。实验室检查结果显示血清嗜酸性粒细胞计数为7×10³/μL（正常范围为0 - 4）。对患者左大腿斑块进行4毫米钻孔活检，显示为弥漫性皮炎，有无数嗜酸性粒细胞，并形成“火焰状图形”。组织学上，这些发现符合威尔斯综合征（WS）的诊断。对可能的潜在恶性肿瘤进行检查发现，该患者患有肾透明细胞癌。在右腹腔镜肾切除术后，手术切缘阴性，皮疹基本消退，从而确诊为副肿瘤性WS。然而，2年后患者出现肝、肺和肋骨转移。尽管接受了高剂量白细胞介素-2、口服舒尼替尼、依维莫司、阿瓦斯汀、阿扎胞苷治疗，目前又接受阿昔替尼治疗，患者的癌症仍在继续进展。我们的病例是首例描述在肾细胞癌患者中出现嗜酸性蜂窝织炎的病例。
