Eosinophilic cellulitis and panniculitis with generalized vesicular pustular id reaction after a molten aluminum burn

Hypersensitivity reactions to aluminum are rare. Sensitization has been reported during the continuous application of aluminum-containing antiperspirants or after the injection of aluminum-adsorbed vaccines and allergen extracts containing aluminum. We report a rare case of a nonhealing ulcer at the site of an accidental molten aluminum burn that showed changes of eosinophilic cellulitis and panniculitis histologically. This process was followed by a generalized vesicular and pustular id reaction. The reactions resolved after 1 month of systemic corticosteroid therapy. Two months later, there was a relapse with bullae over the burn scar, accompanied by a pruritic oozing rash on the ears and face; the lesions were controlled again with systemic corticosteroid treatment. The clinicopathologic features suggest that the eosinophilic cellulitis with panniculitis and id reaction in the present case represents an unusual allergic reaction to aluminum. Aluminum allergy may be considered as a possible underlying process in the setting of eosinophilic cellulitis with panniculitis and id reaction.