Gigantic erythematous plaques with violaceous oedematous borders: a quiz. Wells' syndrome.

A 67-year-old female patient presented with multiple erythematous plaques with violaceous oedematous borders. Lesions first appeared on the trunk, then spread to the lower limbs and finally the face within 10 days (Fig. 1). Lesions showed centrifugal expansion and were very itchy. Laboratory tests showed increased eosinophils (0.08%, normal < 0.07%), lactate dehydrogenase (LDH) (4.43 μmol/s/l, normal 2.25–3.35 μmol/s/l), C-reactive protein (CRP) (14.2 mg/l, normal ≤ 5 mg/l), uric acid (389 μmol/l, normal < 340 μmol/l) and carcinoembryonic antigen (CEA) (6.4 ng/ml, normal < 5 ng/ml) as well as total IgE (272 kU/l, normal < 100 kU/l) and eosinophilic cationic protein (31.1 μg/l, normal < 12 μg/l). Tumour markers Cyfra 21-1 and CA 125 II were within normal ranges. There was no history of blistering disease. Any contact with animals or previous insect bites were denied. Due to bronchial asthma with recurring bronchitis the patient was being treated with montelukast ipatropium bromide, salbutamol, femoterol and beclomethasone spray. Medications, unchanged over the last months, included ramipril, amlodipine and torasemide and levothyroxine. Eighteen months previously, a non-small-cell lung cancer at the right lower lobe had been diagnosed and was removed without further radiotherapy or chemotherapy.