Title : A case report - ALHE presenting at an atypical site with lymphadenopathy.
Background: Angiolymphoid hyperplasia with eosinophilia (ALHE), a uncommon benign vascular proliferation, was initially thought to be a late stage of Kimura’s disease, but is now considered a separate entity. We report a case of ALHE with anemia (Haemoglobin = 10.6gm%)and diabetes mellitus ( Blood Sugar = 178mg%). These associations have not been reported previously. Our patient also had lymphadenopathy, a feature of Kimura’s disease.
Observation: - A 34-year-old male woodcutter by profession presented with itchy multiple skin colored to reddish raised lesions present over lower lip and chin area for 1.5 years. Examination revealed multiple soft to firm, smooth and shiny, erythematous papules and nodules, few are hemorrhagic bleed on touch, varying in size from 0.5cm to 1.5cm present on lower lip and chin with few excoriations. There was an associated regional lymphadenopathy. Known case of Diabetes Mellitus since 6 years. Laboratory reports: Hemoglobin=10.6gm%, Blood Sugar 178 mg% , HBA1c 6.2%, ESR 132 mm/Hr, HCV, HbsAg, VDRL all came Negative. Histopathology revealed increased thick-walled capillaries and venules in upper dermis surrounded by an infiltrate of lymphocytes and eosinophils with mild edema and proliferating fibroblasts. Patient got admitted under surgery for further management.
Key message: - Angiolymphoid Hyperplasia with Eosinophilia rare entity with uncontrolled sugar levels and anemia, along with features over lapping with Kimura’s disease has not been reported previously.