Correspondence

Interferon Alfa Treatment of a Patient with Eosinophilic Cellulitis and HIV Infection

N Engl J Med 1997; 337:641-642August 28, 1997

Article

To the Editor:

In June 1994, a 36-year-old man with human immunodeficiency virus (HIV) infection who was otherwise healthy began to have recurrent swellings of the soft tissue (>20 per month) in various body regions that lasted two to three days and resembled acute cellulitis. This was accompanied by peripheral-blood eosinophilia (32 percent eosinophils). Light microscopy revealed tissue eosinophilia and characteristic “flame figures.” Eosinophilic cellulitis was diagnosed.

In October 1994, we initiated therapy with systemic corticosteroids and dapsone, and the patient did well, with two to three swellings per month. In July 1995, he again noticed increasing swellings and was temporarily treated with 50 mg of prednisolone per day. As an alternative to high-dose glucocorticoids, we started monotherapy with interferon alfa-2a in January 1996. We began with a dose of 3 million IU of interferon alfa-2a subcutaneously every other day (Roferon-A 3-18, Hoffmann–LaRoche, Grenzach-Wyhlen, Germany) and increased the dose to 18 million IU subcutaneously every other day over a period of three months. Despite taking 500 mg of acetaminophen orally one hour before and after the self-administration of interferon alfa-2a, the patient had mild, dose-dependent influenza-like side effects. There was a dose-dependent improvement in the swellings. Since June 1996, he has had one to two mild swellings per month and less than 3 percent eosinophils in peripheral blood. The dose of interferon alfa-2a was reduced to 3 million IU twice a week until March 1997, when the medication was discontinued. Because of decreasing CD4+ counts and an increasing HIV viral load, antiretroviral therapy (zidovudine plus zalcitabine) was initiated in January 1997. As of this writing, the patient has received no other medications, has not relapsed, and still has no symptoms of HIV infection (Centers for Disease Control and Prevention Stage AII; CD4+ count, 675 per microliter; viral load, <300 copies per milliliter).

Eosinophilic cellulitis is associated with infectious diseases, arthropod bites, hematologic cancers, and hypersensitivity reactions.1,2 The combination of eosinophilic cellulitis and HIV infection may be coincidental. However, other eosinophilic conditions, such as eosinophilic folliculitis, are strongly associated with HIV infection.3 Successful therapy with interferon alfa has been described in diseases with blood eosinophilia.4 The inhibitory role of interferon alfa on granular release may be mediated by eosinophils expressing a functional interferon alfa receptor.5

Ralf Husak, M.D.
Sergij Goerdt, M.D.
Constantin E. Orfanos, M.D.
Free University of Berlin, 12200 Berlin, Germany

5 References

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Citing Articles (8)

Citing Articles

1. 1

   D. H. McGibbon. 2010. Subcutaneous Fat. , 1-49.
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2. 2

   T. Ohtsuka. (2009) Oral tacrolimus treatment for refractory eosinophilic cellulitis. Clinical and Experimental Dermatology 34:8, e597-e598
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3. 3

   J. Utikal, W.K. Peitsch, N. Kemmler, N. Booken, R. Hildenbrand, R. Gladisch, S. Goerdt, M. Goebeler. (2007) Bullous eosinophilic cellulitis associated with ulcerative colitis: effective treatment with sulfasalazine and glucocorticoids. British Journal of Dermatology 156:4, 764-766
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4. 4

   T. Zeeli, M. Feinmesser, R. Segal, M. David. (2006) Insect-bite-like Wells' syndrome in association with mantle-zone lymphoma. British Journal of Dermatology 155:3, 614-616
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5. 5

   N. Kemmler, W. K. Peitsch, E. Glorer, S. Goerdt. (2005) Hypereosinophile Dermatitis. Der Hautarzt 56:11, 1060-1067
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6. 6

   Bernhard Hellmich, Wolfgang L Gross. (2004) Recent progress in the pharmacotherapy of Churg-Strauss syndrome. Expert Opinion on Pharmacotherapy 5:1, 25-35
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7. 7

   Meena Moossavi, Darius R. Mehregan. (2003) Wells' syndrome: a clinical and histopathologic review of seven cases. International Journal of Dermatology 42:1, 62-67
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8. 8

   M. Jones-Caballero, S. Pérez-Santos, G. Bermejo-Martínez, M. Lecuna-Echeverría, P. Lazaro-Ochaíta. (2000) Wells’ syndrome and human immunodeficiency virus infection. British Journal of Dermatology 143:3, 672-674
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