PMC6038714_01
A-C. Skin punch biopsy revealed multifocal perivascular mononuclear and eosinophilic inflammation in the superficial dermis, features of superficial perivascular dermatitis. There is neither evidence of vasculitis nor granuloma in this biopsy.
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Based on her eosinophilia while on high dose steroids, history of thromboembolic disease, negative workup, and tissue hypereosinophilia on dermatology biopsy that showed superficial perivascular dermatitis with many eosinophils (Fig. 1) as well as mild eosinophilia on colon biopsy (Fig. 2), the patient was diagnosed with idiopathic hypereosinophilic syndrome.