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Eosinophilic annular erythema following influenza virus infection

Eosinophilic annular erythema (EAE) is a rare eosinophilic dermatosis presenting with recurrent annular erythematous lesions with central clearance and centrifugal enlargement. It is relatively newly described entity characterized by prominent tissue eosinophilia. It was first mentioned by Peterson and Jarratt in 1981 as annular erythema of infancy since its occurrence was only described in children. The first case of EAE in adults was described by Kahofer et al. in 2000. The etiology of this disorder is unclear and usually there is absence of an identifiable exposure or disease, but it has been suggested that EAE could be considered as hypersensitivity reaction to an unidentified allergen. It has also been suggested there is a possible association of EAE with underlying conditions like chronic borreliosis, autoimmune thyroid disease, and renal cell carcinoma but none of them have been convincingly linked to the development of EAE. We report a case of EAE following influenza infection. A 21-year- old male patient presented with erythematous annular pruritic lesions distributed on his trunk, upper and lower extremities accompanied with itch. Review of recent medical history showed that three weeks before EAE occurred, patient developed symptoms of flu and was treated with analgesic and antipyretic medications for symptomatic relief. Skin examination revealed multiple erythematous and annular papules and plaques with scales. No mucosal lesions were present, and the rest of the physical examination disclosed no abnormalities. Diagnosis of EAE was made upon recognition of clinical presentation and results of skin biopsy histopathologic analysis. Routine laboratory findings were within the normal ranges. Serology for syphilis, Borrelia burgdorferi as well as a potassium hydroxide microscopic examination for a fungal infection and stool examination for parasites were all negative and there was no clinical sign of an active underlying neoplastic process. Serology for Influenza B virus was positive indicating recent infection. We suspect that in this case, EAE was triggered by flu since its onset occurred one week after it. Patient was initially treated with topical steroids and oral antihistamines which resulted in involution of existing cutaneous lesions but did not prevent the occurrence of new ones. After further 4 weeks there was significant improvement and clearance of almost all previous skin lesions. This case reports infection with influenza virus as possible trigger event for EAE that to our best knowledge is the first mentioned in available literature.

Annular Erythema ; Influenza virus

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