Case Number : Case 2185 - 24 October 2018 Posted By: Dr. Hafeez Diwan

At first glance, the history of multiple red nodules plus the inflammatory infiltrate, mucin and eosinophils made me think about persistent insect bite reacion. But then I saw within this dense dermal inflammatory infiltrate composed of lymphoid cells and eosinophils, some vessels with proeminent endothelia. Despite not been so common the presentation of multiple nodules, I think this is a case of ALHE (epithelioid hemangioma).

I favor persistent insect bite reaction.

Nice suggestion about ALHE but for me it wolud be ver unusual.

Waiting for the final answer.

There are three distinctive features: 1) EOSINOPHILIC VASCULITIS, 2) DERMAL PROMINENT MUCIN 3) some interface vacuolar dermatitis. Recurrent Cutaneous Eosinophilic Vasculitis could be an option. Insect bite is another good spot. But I favor an eosinophilic vasculitis in a probably systemic Lupus. 

I ended up calling this angiolymphoid hyperplasia with eosinophilia.