title: Eosinophilic leukocytoclastic vasculitis - a spectrum ranging from Wells' syndrome to Churg-Strauss syndrome?
abstract: BACKGROUND
  Wells' syndrome is defined as an inflammatory disorder with the histopathological presence of eosinophilic infiltrates and flame figures in the absence of vasculitis. Eosinophilic leukocytoclastic vasculitis shows eosinophilic infiltrates in combination with vasculitic changes. And Churg Strauss Syndrome comprises all three characteristics - eosinophilic infiltrates, vasculitis and flame figures.
  
  
  OBJECTIVE
  To determine whether these three diseases are distinct entities or different manifestations of a similar clinicopathologic process.
  
  
  METHODS
  Histopathological samples and clinical courses of 17 patients with eosinophilic infiltrates, flame figures and clinical features of Wells' syndrome were re-evaluated. Histopathologically, we focused on the presence or absence of vasculitic features. Clinically, we included only patients who were diagnosed with Wells' syndrome at least once in the course of their disease.
  
  
  RESULTS
  4 patients were finally diagnosed with Wells' syndrome, 5 with eosinophilic leukocytoclastic vasculitis and 6 with Churg Strauss syndrome. Further, we had one case of an overlap between Wells' syndrome and eosinophilic vasculitis and one case of Wegener granulomatosis. Vasculitic features were found in the samples of all patients.
  
  
  CONCLUSIONS
  Histologically, we find vasculitic features in typical presentations of Wells' syndrome. Clinically, we find typical features of Wells' syndrome in patients finally diagnosed with eosinophilic leukocytoclastic vasculitis or Churg Strauss syndrome. Furthermore, we have observed and formerly reported 3 patients with progression from Wells' syndrome to Churg Strauss syndrome. Thus, we assume that eosinophilic leukocytoclastic vasculitis might form a bridge between Wells' syndrome and Churg Strauss syndrome.
authors.affiliation: Department of Dermatology and Venereology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
authors.forename: Gudrun
authors.initials: G
authors.lastname: Ratzinger
authors.affiliation: Department of Dermatology and Venereology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
authors.forename: Julia
authors.initials: J
authors.lastname: Zankl
authors.affiliation: Department of Dermatology and Venereology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
authors.forename: Klaus
authors.initials: K
authors.lastname: Eisendle
authors.affiliation: Department of Dermatology and Venereology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Zelger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002481:Cellulitis / Q000473:pathology*; D002648:Child; D015267:Churg-Strauss Syndrome / Q000473:pathology*; D004802:Eosinophilia / Q000473:pathology*; D004804:Eosinophils; D005260:Female; D006801:Humans; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D018366:Vasculitis, Leukocytoclastic, Cutaneous / Q000473:pathology*
keywords: Churg-Strauss syndrome; Wells’ syndrome; eosinophilic leukocytoclastic vasculitis