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Eosinophilic cellulitis (Wells syndrome) is an uncommon recurrent inflammatory dermatosis. It is characterized by wide clinical variability comprising itching and/or burning tender erythematous lesions, sometimes with urticaria, vesicles and/or bullae, and granulomatous eosinophilic infiltrates in the dermis. The condition was first described by Wells in 1971, and, to date, fewer than 200 cases have been reported in the literature. The histological features are dependent on the stage of the disease, although dermal edema, marked eosinophilic infiltrate without signs of vasculitis, and flame figures are characteristic. Peripheral eosinophilia is frequent [1]. We report the case of a 67-year-old man with history of recurring episodes of erythema lasting 1-3 days, as well as occasional concomitant edema of the limbs, tongue, and face occurring approximately every 2 weeks for the last 30 years. No trigger factors, including drugs, could be identified. Values for complete white cell blood count (including eosinophils), tryptase, functional C1-inhibitor esterase, and C4 were within the normal range. A computed tomography scan of the thorax and abdomen was unremarkable, with no signs of malignancy or inflammatory lesions. Analysis of lymphocyte populations in peripheral blood using flow cytometry did not reveal a monoclonal lymphocytic population. Autoimmune testing for antinuclear antibodies and extractable nuclear antigens was negative. Parasitic infections were excluded by stool and serological tests. Prick tests and specific IgE for food allergy were negative, and total IgE was not elevated. A skin biopsy of the arm performed in 2007 revealed a dense dermal perivascular and interstitial lymphocytic and histiocytic inflammatory infiltrate associated with abundant eosinophils and flame figures compatible with Wells syndrome. Initially, the patient was treated with antihistamines at up to 4-fold higher than the licensed dose, then with topical and systemic corticosteroids, followed by azathioprine up to 150 mg daily, tranexamic acid up to 1000 mg 3 times daily, and, finally, a gluten-free diet. None of these approaches was successful. Despite eradication of Helicobacter pylori, the recurrent skin lesions and edema persisted. The patient was lost to follow-up and treated by various doctors. Detailed data are not available. He eventually came to our clinic 10 years later in 2017 because of exacerbation of skin symptoms while receiving antihistamines and topical corticosteroids. A new skin biopsy (Figure) revealed a dermal infiltrate of perivascular and interstitial lymphocytes and histiocytes with

Long-term Remission of Wells Syndrome With Omalizumab