Breaking the Blister: A Case Report of Bullous Wells’ Syndrome Resolved with Oral Terbinafine
Bibliographic record
Abstract
Eosinophilic cellulitis (Wells' syndrome) is a rare inflammatory dermatosis, characterized by erythematous skin lesions, edema, and eosinophilic infiltration into the dermis. While typically affecting the limbs, it is uncommon for the condition to present as bullae on the feet. Most cases are idiopathic; however, triggering factors may include arthropod bites, certain medications, and viral, bacterial, or parasitic infections. In this case, a 52-year-old woman presented with recurrent pruritic, blistering eruptions on her feet over the past year. The lesions were non-responsive to multiple treatments, including topical and oral steroids, several antibiotics, and methotrexate. She was diagnosed with eosinophilic cellulitis by histopathology, possibly triggered by tinea pedis and onychomycosis. A three-month course of oral terbinafine resolved her fungal infection and recurrent eosinophilic cellulitis. This atypical presentation, including persistent scaly patches and bullae resistant to known treatments for eosinophilic cellulitis, highlights the challenges clinicians face when diagnosing this condition among a broad differential. It should be considered for any unexplained recurrent cellulitis-appearing inflammatory skin condition, not responsive to usual therapy. Additional triggers of eosinophilic cellulitis should be considered beyond those already identified in the literature, such as tinea pedis and onychomycosis as presented in this unique case. Addressing the underlying cause may lead to complete remission of eosinophilic cellulitis.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".