title: Recurrent paraneoplastic wells syndrome in a patient with metastatic renal cell cancer.
abstract: A 58-year-old man with a history of hyperlipidemia and hypertension presented to the dermatology clinic with a 3-month history of a sudden onset, progressively worsening pruritic eruption involving the torso and extremities. Prior treatment included azithromycin and oral and intramuscular steroids, without improvement. Laboratory results demonstrated a serum eosinophil count of 7x10(3)/uL (normal 0-4). A 4-mm punch biopsy of the plaque on the patient's left thigh revealed a diffuse dermatitis with innumerable eosinophils with formation of "flame figures." Histologically, these findings are consistent with a diagnosis of Wells syndrome (WS). A work up for possible underlying malignancy found that the patient had underlying clear cell renal carcinoma. The eruption largely resolved following right laparoscopic nephrectomy with negative surgical margins, thus confirming the diagnosis of paraneoplastic WS. However, 2 years later the patient developed metastasis to his liver, lungs, and ribs. The patient's cancer has continued to progress despite treatment with high-dose interleukin-2, oral sunitinib, afinitor. avastin, azacytidine, and currently axitinib. Our case is the first to describe eosinophilic cellulitis arising in a patient with underlying renal cell carcinoma.
authors.affiliation: University of Kansas Medical Center.
authors.forename: Anand
authors.initials: A
authors.lastname: Rajpara
authors.forename: Ana
authors.initials: A
authors.lastname: Liolios
authors.forename: Garth
authors.initials: G
authors.lastname: Fraga
authors.forename: Joseph
authors.initials: J
authors.lastname: Blackmon
mesh_terms: D002292:Carcinoma, Renal Cell / Q000175:diagnosis* / Q000556:secondary*; D002481:Cellulitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology*; D002990:Clobetasol / Q000627:therapeutic use; D004802:Eosinophilia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology*; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications* / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010257:Paraneoplastic Syndromes / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology
chemical_list: D005938:Glucocorticoids; D002990:Clobetasol