Abstract:

Hypereosinophilic syndrome frequently involves the skin, lung, and gastrointestinal tract with skin disease often being the first sign of disease. Skin findings are variable, but may include psoriasiform dermatitis, urticaria, angioedema, atopic dermatitis, or erythroderma. Here we report two cases of hypereosinophilic syndrome that had varying clinical and histological features, which mimicked common dermatoses. One patient presented with a new widespread papulosquamous eruption with clinical and histologic findings consistent with psoriasis. Two months after the psoriasis diagnosis he developed peripheral eosinophilia and diffuse lymphadenopathy. A bone marrow biopsy confirmed hypereosinophilic syndrome and his disease responded to systemic steroids. Another patient presented with a few scattered round eczematous plaques. Histologically, the plaques showed a spongiotic dermatitis with mixed perivascular inflammatory infiltrate composed of lymphocytes, histiocytes and few scattered eosinophils. Three months after the onset of the rash he developed diarrhea and work-up revealed a persistently elevated eosinophil count. A bone marrow biopsy confirmed hypereosinophilic syndrome. In both of these cases neither the cutaneous morphology nor histology demonstrated findings specific for hypereosinophilic syndrome. In conclusion, regardless of the cutaneous pathology, patients presenting with new and unexplained hypereosinophilia should prompt a clinician to consider hypereosinophilic syndrome. The possibility of hypereosinophilic syndrome should not be discounted if the patient lacks abundant eosinophils on cutaneous histology. With such widely variable findings, hypereosinophilic syndrome could be included in the list of great imitators such as sarcoidosis and syphilis.

Financial Disclosure:
No current or relevant financial relationships exist.

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Jennifer Scott, MD, PhD