Wells' syndrome: report of a case and review of the literature

A 17-year-old woman presented with pruritic papules and plaque wheals on th e upper and lower extremities, back, chest, and abdomen, which had appeared 4 months previously. Previous medical history revealed two surgical operat ions for ovarian cysts (the latter was 2 weeks prior to admittance to the h ospital). There was family (brother) but no personal history of atopy, with no known drug allergies. A prior biopsy demonstrated urticaria. Physical examination revealed symmetric, widespread, pink-red plaques with central clearing mostly on the buttocks, but also on the upper and lower ex tremities and trunk. With pressure, the lesions almost disappeared. Lymph n odes could not be palpated, and all other systems were normal (Figs 1-3). Initial laboratory studies revealed the following: hemoglobin 10.8-11.7 g%, white blood cells (WBC) 5210-8070/muL, platelets 402,000/muL, venereal dis ease research laboratory (VDRL) test negative, cryoglobulins negative, live r and kidney function normal, antinuclear antibodies (ANA) and anti-DNA nor mal, immunoglobulin E (IgE) 29IU/mL, complement and other immunoglobulins w ere within normal values. Urinalysis and urine cultures were normal. There were no parasites in the feces. Sinus and chest X-ray were normal, as was a n ear, nose and throat (ENT) examination. An elevated sedimentation rate (2 3/58) was obtained. A second biopsy revealed features compatible with Wells ' syndrome (Fig.4). Treatment was initiated with prednisone 40 mg for several weeks with taperi ng of the dose by 5 mg every 3-4 days, along with alumag solution 15 cm(3) four times per day.