Medical & Clinical Research

Author(s): Dr Malini Alexander, Dr Samual Blayney

This case study represents an unusual presentation female in her seventies who presented with a chronic eosinophilic rash without systemic involvement on a background of psoriatic arthritis (pSA) and Sjogren’s Syndrome (sSS). Biopsy of the lesions identified flame figures. The differentials for such lesions are wide, however this case discusses three of the most likely differentials including Eiosinophilic Cellulitis (Well’s Syndrome), Eosionophilic Granlomatosis with Polyangiitis (Churg Strauss Syndrome) and Granulomatous Dermatitis (GD). A common aberrant eiosinophilic response is dicussed and a review of the literature identifies the possibility that these diagnoses represent a single spectrum of disease, rather than separate clinical entities. Whilst the provoking incident was not able to be established in this case, the possibility of covid-19 vaccination contributing to the development of lesions is discussed. This case highlights the importance of conducting skin biopsies of unusual lesions that do not follow an expected clinical course and that skin biopsies might need to be performed opportunistically by emergency departments especially in rural areas where dermatology services are lacking. A lack of knowledge of various complex systemic diseases that present with unusual skin lesions often results in missed diagnosis and delayed patient care. Education of primary care physicians and healthcare professionals working in emergency departments is required to ensure timely biopsy and appropriate serology with screening for underlying systemic diseases including malignancy is required to prevent missed diagnosis and delayed care.