Spontaneously Regressive Angiolymphoid Hyperplasia With Eosinophilia: A Case Report With Evidence Of Dendritic Cells Proliferation

Abstract

To the Editor: A 79‐year‐old male presented with multiple asymptomatic, erythema, and nodules on the right‐front scalp for about three weeks. The number of the nodules gradually increased. Physical examination revealed multiple violaceous, reddish nodules measuring 0.5–1.0 cm and infiltrative plaques located on the right frontal scalp, without evidence of lymphadenopathy [Figure 1a]. Serological examination revealed the elevated level of leukocytes. Peripheral eosinophil and serum IgE were normal. Histopathology revealed vascular hyperplasia in the dermis. The larger vessels were lined by characteristic “hobnail” endothelial cells, which protruded into the lumen and have ovoid nuclei and intracytoplasmic vacuoles. There was mixed inflammatory infiltration of prominently eosinophils, histiocytes, lymphocytes, and neutrophils [Figure 1c]. Immunohistochemical examination revealed dendritic cells of epidermis and dermis increased, with positive CD1a staining, the linear density of CD1a positive dendritic cells was 70–80/mm (normal range 42.7 ± 17.9/mm) [Figure 1d]. Based on the history, clinical examination, and histopathology, the patient was diagnosed with angiolymphoid hyperplasia with eosinophilia (ALHE). The patient did not use any topical drug. The lesions regressed spontaneously after one month [Figure 1b].