Case Number : Case 1814 - 11 May - Dr Arti Bakshi Posted By: Guest

Once again Dr Arti Bakshi has a lovely case for you to check out.

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Geoff Cross - DermpathPRO Projects

I don't know if the patient is an advanced immunocompromised HIV or cancer-related or a japanese, but want go with Eosinophilic Pustular Folliculitis.  

Same impression, eosinophilic folliculitis but I also remember a case that Arti presented (there was a video posted on dermpathpro) of eosinophilic dermatosis of haematological malignancy so would add that to the differential. Cpc important as patient is the age for CLL, etc

Yes, Raul. In this particular case i favour a hematologic malignancy related eosinophilic folliculitis rather than a generic eosinophilic dermatosis ( Sweet like for example) but totally agree with you. 

 I would check first the PAS for dermatophytes (I'm sure they did). Second eosinophilic folliculitis (ask history for: HIV, malignancies)

Eosinophilic pustular folliculitis

2 hours ago, vincenzo polizzi said:

I don't know if the patient is an advanced immunocompromised HIV or cancer-related or a japanese, but want go with Eosinophilic Pustular Folliculitis.  

Agree

Sub epidermal oedema is striking and not usually seen in eosinophilic pustular folliculitis. I would also like to exclude dermatophyte and arthropod assault.

23 minutes ago, Neil Catterall said:

Sub epidermal oedema is striking and not usually seen in eosinophilic pustular folliculitis. I would also like to exclude dermatophyte and arthropod assault.

Does the edema suggest Well's syndrome?

Eosinophilic pustular folliculitis. Detailed clinical information will allow the distinction between the Ofuji’s classic type, the HIV-associated type, and the drug-induced type. Special stains are required to rule out infectious agents.

Eosinophilic pustular folliculitis. Agree Ofuji's. Early varicela-zoster? Eosinophilic infiltrante don't favour that ....Inmunostain for VZV because great involvement in sebáceous gland? 

21 hours ago, Raul Perret said:

Same impression, eosinophilic folliculitis but I also remember a case that Arti presented (there was a video posted on dermpathpro) of eosinophilic dermatosis of haematological malignancy so would add that to the differential. Cpc important as patient is the age for CLL, etc

Great that you actually remembered the case in the video!! ...but this is not the same case. That case was posted here on dermpathpro in 2016 by Dr Carr  https://dermpathpro.com/spot-diagnosis-1/2015-spot-diagnoses/october-2015/case-1387-16-october-r1444/

Yes, histologically this is Eosinophilic pustular folliculitis and the d/d includes Ofuji's, HIV associated and drug induced EF. (PAS for fungi was negative).

Agree that subepidermal oedema is prominent, but the striking follicular involvement would be odd for insect bite reaction or Well's syndrome. The patient had actually been started on allopurinol for gout and he developed this rash within a few days of starting the drug. So, this is an Allopurinol induced Eosinophilic folliculitis (following CPC)