Toxocariasis and Wells' syndrome: a causal relationship?

BACKGROUND: The etiology of Wells' syndrome or eosinophilic cellulitis is unknown. Various triggering factors, such as myeloproliferative disorders, lymphoma, infections/infestations, insect bites and drugs have been reported. In 1979, Wells was the first who pointed out some common features of eosinophilic cellulitis and skin lesions in toxocariasis.

OBJECTIVE: We report 2 patients who exhibited the characteristic clinical and histological features of Wells's syndrome together with elevated antibody titers to the excretory-secretory antigen of Toxocara canis.

RESULTS: In both patients, the skin lesions disappeared after oral albendazole treatment and no recurrences were observed. The clinical response was followed by a normalization of the Toxocara antibody titer. In contrast, a patient with eczematoid skin lesions, eosinophilia and an elevated Toxocara antibody titer did not benefit from albendazole treatment despite serological normalization.

CONCLUSION: Taken together, these cases lend support to a causal relationship of Toxocara in selected patients with Wells' syndrome.