Track: Case Reports

Topic: Infectious Diseases

Abstract:

Eosinophilic folliculitis is an inflammatory dermatosis of unknown etiology. Although it can affect healthy individuals, it tends to affect individuals in an immunocompromised state. Eosinophilic folliculitis is challenging to diagnose because its lesions resemble other common dermatologic conditions. We present a 72-year-old male with a past medical history of HIV currently not on ART (last viral load 82k on 9/2023), Hepatitis C, and COPD, who presented to the emergency department for weeks of pruritis rash, fatigue, and lightheadedness. The physical exam was notable for dispersed scaling facial lesions, an ulcerated lesion on the pinna of the right ear, and diffuse maculopapular rash with overlying excoriations on his extremities and trunk. Given his immunocompromised state, the differential remained broad but included pruritic papular eruption, hepatic pruritis, porphyria cutaneous tarda, scabies, and eosinophilic folliculitis. Infectious Disease (ID), Dermatology, and General Surgery were consulted. ID initiated the patient on ART. Dermatology started Ivermectin 200mcg/kg x 1 with a repeat dose in 10 days, given the concern for scabies. In addition, he was started on triamcinolone twice daily, Benadryl as needed, and topical fluocinonide to the scalp twice a day. General Surgery was able to obtain punch biopsies of the skin lesions. Eventually, the pathology resulted in eosinophilic folliculitis. This case illustrates the challenge of correctly diagnosing eosinophilic folliculitis (EF). EF's clinical appearance and pathological findings mimic other dermatological diseases such as acne vulgaris, rosacea, bacterial folliculitis, dermatomycosis, seborrheic dermatitis, follicular mucinosis, and cutaneous t-cell lymphoma.

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Alexandra Baczynski, MD