Wells syndrome and its relationship to Churg–Strauss syndrome

Background  Wells syndrome has been described as an inflammatory disorder based on typical clinical appearance combined with the histopathological presence of eosinophilic infiltrates and flame figures in the absence of vasculitis. Churg–Strauss syndrome, on the other hand, is primarily a diffuse, necrotizing vasculitis but is also typically displaying eosinophils and flame figures. Despite several parallels, the present understanding of these two diseases excludes any pathogenetic relationship. Methods  We describe the clinical course and histopathological appearance of three patients who had initially been diagnosed with Wells syndrome that developed into Churg–Strauss syndrome during the course of their disease. Results  The clinical presentation of all three patients led to the diagnosis of Wells syndrome by independent specialists. Histopathology showed an eosinophilic infiltrate and flame figures next to features of leukocytoclastic vasculitis. Detailed examination revealed asthma bronchiale and additional symptoms indicating Churg–Strauss syndrome. The initial diagnosis of Wells syndrome had to be revised to Churg–Strauss syndrome. Conclusion  We conclude that Wells syndrome could be the starting point of a pathogenetic process that might reach its maximum in Churg–Strauss syndrome. As a clinical consequence, patients with Wells syndrome should be evaluated and followed for Churg–Strauss syndrome.