Recurrent Cellulitis-Like Episodes of the Lower Limbs and Acute Diarrhea in a 30-Year-Old Woman: A Case Report

Patient: Female, 30-year-old Final Diagnosis: Wells syndrome Symptoms: Acute diarrhea • chronic recurrent episodes resembling cellulitis to her lower limbs bs Medication: — Clinical Procedure: Skin biopsy Specialty: Dermatology • Family Medicine OBJECTIVE: Unusual clinical course BACKGROUND: Wells syndrome is an uncommon inflammatory dermatosis that presents as tender or mildly pruritic cellulitis-like eruptions. The clinical presentation can include papular and nodular eruptions, annular plaques, vesicles, bullae, and urticaria. This syndrome can be promoted by inappropriate eosinophilic stimulation by factors that affect normal eosinophil cellular systems. Histologically, during the acute phase, a dense infiltrate of degranulating eosinophils is located in the epidermis and dermis. Wells syndrome mostly has a benign course; however, its recurrences can be frequent over the years. It can be an imitator of bacterial cellulitis leading to ineffective antibiotic courses, which can promote a Clostridioides difficile infection. CASE REPORT: A 30-year-old woman presented with chronic episodes resembling cellulitis on her lower limbs, for the past 5 years. Her past medical and family history was insignificant. She had been prescribed several courses of antibiotics. At this presentation, she had edema in the lower part of her left foot, erythema and pruritus, mild diarrhea, and fever for 4 days. She was diagnosed with a Clostridioides difficile infection with a background of Wells syndrome. She was successfully treated for Clostridioides difficile with metronidazole and probiotics, and had complete clinical remission of the Wells syndrome with mometasone furoate cream and levocetirizine. CONCLUSIONS: This report emphasizes the need for greater vigilance by physicians before making a final diagnosis of infectious cellulitis. Thus, excluding from their differential diagnosis, other dermatological diseases mimicking infectious cellulitis and preventing a possible misdiagnosis, delay of appropriate treatment, future antibiotic-associated complications, and the evolution of antimicrobial-resistant microbes in the community.