Treatment-Resistant Eosinophilic Spongiosis Dermatitis in a Patient With Various Comorbidities: A Case Report

Eosinophilic spongiosis is a principal term for many diseases that display a histopathology of eosinophilic infiltrates in the spongiotic epidermis. Disorders consistent with eosinophilic spongiosis include autoimmune bullous disorders, chronic eczema, and contact dermatitis. In this case report, we present a 38-year-old male with a generalized, pruritic, and erythematous rash that was diagnosed two years prior as eosinophilic spongiosis and venous stasis dermatitis based on the respective biopsies of the skin of the left elbow and of the right lower extremity. The patient reported intense pruritus that required him to wear white cotton gloves to prevent him from further scratching. His social history was notable for current tobacco use and a past history of illicit drug use. Within the two years, the patient also had numerous appointments with various primary care physicians and cardiology to address his mental health and cardiovascular symptoms such as chest pain, dyspnea, and claudication. Alongside receiving a thorough cardiovascular exam workup, the patient tried numerous treatments for his rash and the pruritus, including topical triamcinolone, tacrolimus ointment, steroid injections, hydroxyzine, amitriptyline, and, most recently, dupilumab therapy. Without much improvement with these therapies, the patient's condition remains persistent and increasingly affects his quality of life. This case report highlights the complexity of ongoing assessment and treatment, offering guidance for the care of patients with similar presentations. Educational insights obtained from this report include maintaining broad differential diagnoses, the influence of neuropsychiatry and cardiology in dermatology, and the importance of multidisciplinary care.