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Le Quang M, Solé G, Martin-Négrier ML, Mathis S. Clinical and pathological aspects of toxic myopathies. J Neurol 2024; 271:5722-5745. [PMID: 38907023 DOI: 10.1007/s00415-024-12522-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 06/14/2024] [Accepted: 06/15/2024] [Indexed: 06/23/2024]
Abstract
As the most frequent cause of acquired myopathy, toxic myopathies are characterised by clinicopathological features that vary depending on the mode of action of the drugs or toxins involved. Although a large number of substances can induce myotoxicity, the main culprits are statins, alcohol, and corticosteroids. A rigorous, well-organised diagnostic approach is necessary to obtain a rapid diagnosis. For early diagnosis and management, it is important for clinicians to be aware that most toxic myopathies are potentially reversible, and the goal of treatment should be to avoid serious muscle damage.
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Affiliation(s)
- Mégane Le Quang
- Department of Pathology, University Hospital (CHU) of Bordeaux, Pellegrin Hospital, Place Amélie Raba Léon, 33000, Bordeaux, France
| | - Guilhem Solé
- Department of Neurology, Nerve-Muscle Unit, AOC Reference for Neuromuscular Disorders, University Hospital (CHU) of Bordeaux, Pellegrin Hospital, Place Amélie Raba Léon, 33000, Bordeaux, France
| | - Marie-Laure Martin-Négrier
- Department of Pathology, University Hospital (CHU) of Bordeaux, Pellegrin Hospital, Place Amélie Raba Léon, 33000, Bordeaux, France
| | - Stéphane Mathis
- Department of Neurology, Nerve-Muscle Unit, AOC Reference for Neuromuscular Disorders, University Hospital (CHU) of Bordeaux, Pellegrin Hospital, Place Amélie Raba Léon, 33000, Bordeaux, France.
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2
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Barajas-McGahan M, Tuckfield L, Rice K, Patel R. Atypical Case of Toe-Walking and Hyperpigmented Rash in a 9-year-old Boy. Pediatr Rev 2024; 45:e19-e23. [PMID: 38821902 DOI: 10.1542/pir.2022-005761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/07/2023] [Accepted: 08/30/2023] [Indexed: 06/02/2024]
Affiliation(s)
- Maria Barajas-McGahan
- Valley Children's Pediatric Residency Program affiliated with Stanford School of Medicine, Madera, CA
- Valley Children's Healthcare, Madera, CA
| | - Lynnia Tuckfield
- Valley Children's Pediatric Residency Program affiliated with Stanford School of Medicine, Madera, CA
- Valley Children's Healthcare, Madera, CA
| | - Kerrilynn Rice
- Valley Children's Pediatric Residency Program affiliated with Stanford School of Medicine, Madera, CA
- Valley Children's Healthcare, Madera, CA
| | - Reshma Patel
- Valley Children's Pediatric Residency Program affiliated with Stanford School of Medicine, Madera, CA
- Valley Children's Healthcare, Madera, CA
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3
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Yamada T, Hashimoto E, Suzuki M, Hirose K. Joint Sparing: The Key to Unlocking Early Treatment Success in Eosinophilic Fasciitis. Cureus 2024; 16:e60076. [PMID: 38860063 PMCID: PMC11163252 DOI: 10.7759/cureus.60076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2024] [Indexed: 06/12/2024] Open
Abstract
Delayed diagnosis is recognized as a poor prognostic factor in eosinophilic fasciitis (EF). Elevated serum eosinophil counts, a minor criterion in the diagnostic standards, occur early in the disease course. However, signs such as the groove sign and orange-peel sign typically do not appear in the initial stages, posing challenges for early detection under the current diagnostic criteria. We report a case where the combination of "joint sparing" physical findings and elevated eosinophil counts facilitated early diagnosis and treatment. A 79-year-old woman presented with an acute onset of swelling in the upper and lower limbs. Physical examination revealed non-pitting edema with "joint sparing", and blood tests showed increased eosinophil counts. Contrast-enhanced MRI of the lower limbs showed post-contrast enhancement along the fascia, leading to a diagnosis of EF. The presence of non-pitting edema with "joint sparing" may be a valuable diagnostic indicator for EF. Furthermore, combining this with serum eosinophil counts can enable early diagnosis and treatment, potentially improving patient outcomes.
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Affiliation(s)
- Tatsuki Yamada
- Department of General Medicine and Primary Care, University of Tsukuba Hospital, Tsukuba, JPN
| | - Etaro Hashimoto
- Faculty of Medicine/Department of Primary Care and Medical Education, University of Tsukuba/University of Tsukuba Hospital, Tsukuba, JPN
| | - Masatsune Suzuki
- Department of Primary Care and Medical Education/Department of General Medicine and Primary Care, Faculty of Medicine, University of Tsukuba/University of Tsukuba Hospital, Tsukuba, JPN
| | - Kazuhito Hirose
- Department of General Medicine, Tsukuba Medical Center Hospital, Tsukuba, JPN
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4
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Gómez-Puerta JA, Gente K, Katsumoto TR, Leipe J, Reid P, van Binsbergen WH, Suarez-Almazor ME. Mimickers of Immune Checkpoint Inhibitor-induced Inflammatory Arthritis. Rheum Dis Clin North Am 2024; 50:161-179. [PMID: 38670719 DOI: 10.1016/j.rdc.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
The differential diagnosis of inflammatory arthritis as an immune-related adverse event can be challenging as patients with cancer can present with musculoskeletal symptoms that can mimic arthritis because of localized or generalized joint pain. In addition, immune checkpoint inhibitors can exacerbate joint conditions such as crystal-induced arthritis or osteoarthritis, or induce systemic disease that can affect the joints such as sarcoidosis. This distinction is important as the treatment of these conditions can be different from that of immune-related inflammatory arthritis.
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Affiliation(s)
- José A Gómez-Puerta
- Department of Rheumatology, Hospital Clínic; University of Barcelona, Escala 11-2, Barcelona, Villarroel 170, Barcelona 08036, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Karolina Gente
- Department of Internal Medicine V - Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany
| | - Tamiko R Katsumoto
- Division of Immunology and Rheumatology, Department of Medicine, 300 Pasteur Drive Suite H305, Stanford, CA 94305, USA
| | - Jan Leipe
- Division of Rheumatology, Department of Medicine V, University Hospital Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Mannheim, Heidelberg 68167, Germany
| | - Pankti Reid
- Division of Rheumatology, Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA
| | - Wouter H van Binsbergen
- Department of Rheumatology & Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Center, Meibergdreef 9, 1105AZ (AMC) & De Boelelaan 1117, Amsterdam 1081 HV (VUmc), The Netherlands
| | - Maria E Suarez-Almazor
- Department of Health Services Research, MD Anderson Cancer Center, The University of Texas, 1515 Holcombe Boulevard, Houston, TX 77030, USA
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5
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Ueda Y, Matsubara S. Groove sign in eosinophilic fasciitis. QJM 2024; 117:283-284. [PMID: 37991938 DOI: 10.1093/qjmed/hcad264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Indexed: 11/24/2023] Open
Affiliation(s)
- Y Ueda
- Department of Rheumatic Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - S Matsubara
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
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6
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Cherim A, Bastian AE, Popp CG, Mihon MI, Efrem IC, Vreju AF, Ionescu RA. Eosinophilic fasciitis: unraveling the clinical tapestry of a rare case and review of literature. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2024; 65:341-347. [PMID: 39020550 PMCID: PMC11384037 DOI: 10.47162/rjme.65.2.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Abstract
Eosinophilic fasciitis (EF) remains a diagnostic challenge due to its rarity and resemblance to scleroderma. This case report aims to provide a cohesive exploration of EF's clinical nuances, emphasizing the importance of accurate diagnosis and effective management. A 52-year-old male developed bilateral forearm and calf hardening, along with erythema, pruritus, and pain four months prior to the presentation in our Clinic. The symptoms initially debuted bilaterally in the forearms and progressed to involve the calves, distal arms, and thighs. Clinical examination revealed symmetrical plaques on forearms and calves, featuring erythematous, hyper, and hypopigmented elements extending proximally, a positive "groove sign" and a moderate difficulty in knee joint flexion. Despite these findings, the patient was generally in good condition, without any other notable clinical signs. Initial laboratory findings showed slightly increased percentual eosinophil levels, elevated C-reactive protein (CRP), normal erythrocyte sedimentation rate (ESR), and negative antinuclear and scleroderma specific antibodies. Magnetic resonance imaging (MRI) demonstrated enhanced fascial signal and thickening while the fascia-muscle biopsy revealed marked edema and inflammatory lymphoplasmacytic infiltrate, consistent with the diagnosis of EF. The patient showed a favorable response to systemic corticosteroids. EF predominantly affects males aged 30 to 60 and is characterized by a sudden onset and unclear etiological factors. Differential diagnosis requires careful exclusion of scleroderma and other mimicking conditions. Diagnostic modalities such as skin-muscle biopsy and MRI reveal characteristic findings like inflammatory infiltrate and fascial thickening. Accurate diagnosis and differentiation from scleroderma are crucial, with early intervention involving glucocorticoids and immunosuppressive agents improving long-term outcomes.
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Affiliation(s)
- Aifer Cherim
- Department of Internal Medicine - Medical Semiology, Faculty of Dentistry, University of Medicine and Pharmacy of Craiova, Romania; ,
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7
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Knapp S, Bolko L, Servettaz A, Didier K. [[Eosinophilic fasciitis: From pathophysiology to therapeutics]]. Rev Med Interne 2024:S0248-8663(24)00086-9. [PMID: 38519306 DOI: 10.1016/j.revmed.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/27/2024] [Accepted: 03/07/2024] [Indexed: 03/24/2024]
Abstract
Eosinophilic fasciitis (EF) is a rare connective tissue disorder characterized by painful edema and induration of the limbs and trunk, likely associated with hypereosinophilia and hypergammaglobulinemia. EF causes arthralgia and range of motion limitation, leading to significant functional impairment and poor quality of life. Since its description by Shulman in 1974, over 300 cases have been reported. We present here a review of the latest diagnostic, pathophysiological and therapeutic developments in this disease. Magnetic resonance imaging appears useful to guide diagnosis and biopsy. Diagnosis is based on a deep skin biopsy involving the fascia, which will reveal edema, sclerofibrosis of the muscular fascia and subcutaneous tissue, and an inflammatory infiltrate sometimes composed of eosinophilic polynuclear cells. EF may occur in patients treated with immune checkpoint inhibitors and the diagnosis should be raised in case of cutaneous sclerosis in these patients. The pathophysiology of the disease remains poorly understood, and its management lacks randomized, controlled, blinded trials. First-line treatment consists in oral corticosteroid therapy, sometimes combined with an immunosuppressant, mainly methotrexate. A better understanding of the pathophysiology has opened new therapeutic perspectives and clarified the role of targeted therapies in the management of EF, such as interleukin-6 inhibitors, whose efficacy has been reported in several cases.
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Affiliation(s)
- S Knapp
- Service de médecine interne, maladie infectieuse et immunologie clinique, hôpital Robert-Debré, CHU de Reims, rue du Général-Kœnig, 51092 Reims cedex, France
| | - L Bolko
- Service de rhumatologie, hôpital Maison Blanche, CHU de Reims, Reims, France
| | - A Servettaz
- Service de médecine interne, maladie infectieuse et immunologie clinique, hôpital Robert-Debré, CHU de Reims, rue du Général-Kœnig, 51092 Reims cedex, France; EA 7509 IRMAIC, université de Reims Champagne-Ardenne, Reims, France
| | - K Didier
- Service de médecine interne, maladie infectieuse et immunologie clinique, hôpital Robert-Debré, CHU de Reims, rue du Général-Kœnig, 51092 Reims cedex, France; EA 7509 IRMAIC, université de Reims Champagne-Ardenne, Reims, France.
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8
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Stubbs LA, Ogunbona O, Beil E, Szafron V, Adesina A, Anvari S, Lai J, Ramirez A, Ditzler MG, DeGuzman M. Juvenile eosinophilic fasciitis: a single center case series. Pediatr Rheumatol Online J 2024; 22:29. [PMID: 38395889 PMCID: PMC10893626 DOI: 10.1186/s12969-024-00960-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/17/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Eosinophilic fasciitis (EF) is a rare disease characterized by skin induration and musculoskeletal abnormalities. Diagnostic criteria for EF are based on adult populations. There is a need to expand the literature on EF in children due to limited reported cases and potential differences compared to adults. METHODS We conducted a retrospective review of medical records for six pediatric patients diagnosed with EF at our institution between November 2011 and April 2023. Inclusion criteria required patients to be under 18 years of age at the time of diagnosis and to have confirmed diagnosis through clinical history, imaging, and histology. RESULTS Most of our cohort were female (83%) and non-Hispanic white (50%). Age at diagnosis ranged from 4 to 16 years. Duration of symptoms before diagnosis varied from 1 to 12 months. Follow-up periods ranged from 14 to 123 months. Concurrent medical conditions included localized scleroderma, acquired thrombophilia, and juvenile idiopathic arthritis. Patients presented with progressive painful swelling, severe joint limitations, and positive prayer sign. Initial regimens involved corticosteroids and methotrexate. Hydroxychloroquine, immunoglobulin, mycophenolate mofetil, rituximab, and tocilizumab were also used depending on the patient's disease severity and course. CONCLUSIONS Juvenile EF may manifest as swelling and progressive induration without apparent skin abnormalities. Unlike adult populations, no underlying malignancies or associations with trauma were observed in our cohort. Our cases did not exhibit systemic involvement observed in previous studies on juvenile EF. While non-specific, the prayer sign may aid in early recognition of juvenile EF and help prevent long-term disability.
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Affiliation(s)
- Leigh A Stubbs
- Department of Pediatrics, Division of Rheumatology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Oluwaseun Ogunbona
- Department of Pathology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
- Department of Pathology and Genomic Medicine, Houston Methodist, Houston, TX, USA
| | - Emily Beil
- Department of Pediatrics, Division of Rheumatology, Texas Children's Hospital, Feigin Tower, 1102 Bates, Ste. 330, Houston, TX, TX 77030, USA
| | - Vibha Szafron
- Department of Pediatrics, Division of Allergy and Immunology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Adekunle Adesina
- Department of Pathology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Sara Anvari
- Department of Pediatrics, Division of Allergy and Immunology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Jamie Lai
- Department of Pediatrics, Division of Rheumatology, Texas Children's Hospital, Feigin Tower, 1102 Bates, Ste. 330, Houston, TX, TX 77030, USA
| | - Andrea Ramirez
- Department of Pediatrics, Division of Rheumatology, Texas Children's Hospital, Feigin Tower, 1102 Bates, Ste. 330, Houston, TX, TX 77030, USA
| | - Matthew G Ditzler
- Department of Radiology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Marietta DeGuzman
- Department of Pediatrics, Division of Rheumatology, Texas Children's Hospital, Feigin Tower, 1102 Bates, Ste. 330, Houston, TX, TX 77030, USA.
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Boussaa H, Kamoun M, Miladi S, Makhlouf Y, Abdelghani KB, Fazaa A, Laatar A. The first case of SARS-CoV-2-induced eosinophilic fasciitis. Mod Rheumatol Case Rep 2023; 8:224-228. [PMID: 37902576 DOI: 10.1093/mrcr/rxad063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/01/2023] [Accepted: 10/06/2023] [Indexed: 10/31/2023]
Abstract
Eosinophilic fasciitis (EF), also known as Shulman syndrome, is a rare auto-immune fibrosing disorder of the fascia. Etiopathogeny of EF is still unclear. Nowadays, it is widely known that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may induce hyper-stimulation of the immune system. Several cases with fasciitis and rhabdomyolysis induced by coronavirus disease 2019 vaccines have been reported in the literature. Herein, we report the first case of EF possibly triggered by SARS-CoV-2 infection. A 45-year-old Tunisian woman, with no medical history, presented to our department with severe widespread muscle pain noticed one month after a SARS-CoV-2 infection. Physical examination showed an induration of the skin and subcutaneous tissue of the arms, forearms and legs with a restricted joint mobility. The level of eosinophils was 430 E/mm3 (6.1%) [1-4%]. Electromyography and creatine kinase levels were normal. Myositis-related antibodies were negative. Magnetic resonance imaging of the left arm showed high-intensity signal and thickness of the fascia without evidence of muscle or bone involvement. A muscular biopsy from the right deltoid showed thickening and inflammation of the fascia. The patient received intraveinous injections of 1000 mg of methylprednisolone for 3 days with an oral relay of 1 mg/kg per day of prednisone equivalent during 4 weeks. At one-month follow-up, a significant improvement of the skin induration and myalgia was observed, with a disappearance of the biological inflammatory syndrome. This brief report suggests a potential link between SARS-CoV-2 infection and new-onset of auto-immune fasciitis.
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Affiliation(s)
- Hiba Boussaa
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Rheumatology Department, Mongi Slim University Hospital, Tunis, Tunisia
| | - Mariem Kamoun
- Rheumatology Department, Mongi Slim University Hospital, Tunis, Tunisia
| | - Saoussen Miladi
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Rheumatology Department, Mongi Slim University Hospital, Tunis, Tunisia
| | - Yasmine Makhlouf
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Rheumatology Department, Mongi Slim University Hospital, Tunis, Tunisia
| | - Kawther Ben Abdelghani
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Rheumatology Department, Mongi Slim University Hospital, Tunis, Tunisia
| | - Alia Fazaa
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Rheumatology Department, Mongi Slim University Hospital, Tunis, Tunisia
| | - Ahmed Laatar
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Rheumatology Department, Mongi Slim University Hospital, Tunis, Tunisia
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10
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Khaleel M, Ayyad M, Khalil NCN, Tarayrah O, Tumezeh M, Bannoura S. Eosinophilic Fasciitis Presenting as Chronic Nonspecific Symptoms in a Young Adult. Oxf Med Case Reports 2023; 2023:omad131. [PMID: 38145270 PMCID: PMC10735454 DOI: 10.1093/omcr/omad131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/03/2023] [Accepted: 10/16/2023] [Indexed: 12/26/2023] Open
Abstract
Eosinophilic fasciitis (EF) is a rare inflammatory disease affecting various connective tissues. It is characterized by induration of the skin as well as scleroderma-like manifestations that are progressive and bilaterally symmetrical. Additionally, the joints and muscles are commonly involved, and rarely, there can be involvement of internal organs. The diagnosis of EF is based on clinical, laboratory, radiological, and a full-thickness skin biopsy involving the fascia. The biopsy is often diagnostic and shows eosinophilic inflammation. Systemic corticosteroids specifically prednisone and prednisolone remain the preferred treatment of choice and may be combined with immunosuppressive therapy in a subset of patients. We herein report a patient complaining of chronic nonspecific symptoms that were diagnosed with EF. The patient was treated with steroids with marked improvement of his overall condition.
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Affiliation(s)
- Mansour Khaleel
- Department of Internal Medicine, Makassed Hospital, Jerusalem, IL
| | - Mohammed Ayyad
- Internal Medicine Department, Al Quds University, Abu Dis, State of Palestine
| | - Nabil C N Khalil
- Department of Internal Medicine, Makassed Hospital, Jerusalem, IL
| | - Omar Tarayrah
- Department of Internal Medicine, Makassed Hospital, Jerusalem, IL
| | - Muath Tumezeh
- Department of Internal Medicine, Makassed Hospital, Jerusalem, IL
| | - Sami Bannoura
- Department of Pathology, Makassed Hospital, Jerusalem, IL
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11
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Chohan S, Wong N, Hanson J, Darwish M, Osto M, Daveluy S. Diagnostic imaging for eosinophilic fasciitis: A systematic review. JAAD Int 2023; 13:10-12. [PMID: 37575513 PMCID: PMC10413342 DOI: 10.1016/j.jdin.2023.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Affiliation(s)
- Sikander Chohan
- Wayne State University School of Medicine, Detroit, Michigan
| | - Nikita Wong
- Wayne State University School of Medicine, Detroit, Michigan
| | - Jamie Hanson
- Saint Louis University School of Medicine, St Louis, Missouri
| | - Mohammad Darwish
- St. George’s University, University Centre Grenada, West Indies, Grenada
| | - Muhammad Osto
- Wayne State University School of Medicine, Detroit, Michigan
| | - Steven Daveluy
- Department of Dermatology, Wayne State University, Detroit, Michigan
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12
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Shahriari N, Mazori DR, Shahriari M, Taylor D, Shaw K, LaChance AH, Femia AN, Vleugels RA. Utility of magnetic resonance imaging in the diagnosis of eosinophilic fasciitis: A multicenter retrospective cohort study. J Am Acad Dermatol 2023; 89:1313-1315. [PMID: 37659455 DOI: 10.1016/j.jaad.2023.08.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 08/09/2023] [Accepted: 08/23/2023] [Indexed: 09/04/2023]
Affiliation(s)
- Neda Shahriari
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Daniel R Mazori
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Mona Shahriari
- Central Connecticut Dermatology, Cromwell, Connecticut; Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Dustin Taylor
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Katharina Shaw
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Avery H LaChance
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alisa N Femia
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Ruth Ann Vleugels
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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13
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Treichel AM, Zheng DX, Ranasinghe GC, Zeft AS, Bergfeld WF, Bayart CB. Eosinophilic fasciitis in a young male auto mechanic exposed to organic solvents. Reumatismo 2023; 75. [PMID: 37721352 DOI: 10.4081/reumatismo.2023.1539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 07/08/2023] [Indexed: 09/19/2023] Open
Abstract
We report a case of eosinophilic fasciitis in a teenage auto mechanic who was most likely affected by occupational exposure to organic solvents, including the aromatic hydrocarbons benzene, trimethylbenzene, naphthalene, toluene, and xylene. The patient presented with an 8-month history of painful induration of his extremities and an abnormal gait. A deep excisional biopsy of the fascia was obtained, demonstrating subcutaneous fibrosis with perivascular and interstitial inflammation, with lymphocytes and plasma cells spilling into the sclerosed fascia, and focal fibrinoid necrosis. Treatment was begun with intravenous pulse doses of methylprednisolone, prednisone (20 mg daily), and subcutaneous methotrexate (25 mg weekly), and the patient's painful induration had resolved and gait had normalized at the 6-month follow-up. Our case suggests that exposure to organic solvents could be implicated in the pathogenesis of eosinophilic fasciitis and highlights the importance of a thorough occupational history to prevent repeat exposures to potentially causative agents.
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Affiliation(s)
- A M Treichel
- Department of Dermatology, Cleveland Medical Center University Hospital, Case Western Reserve University, Cleveland, Ohio.
| | - D X Zheng
- Department of Dermatology, Cleveland Medical Center University Hospital, Case Western Reserve University, Cleveland, Ohio.
| | | | - A S Zeft
- Division of Pediatric Rheumatology, Department of Pediatrics, Cleveland Clinic, Ohio.
| | - W F Bergfeld
- Department of Dermatology, Cleveland Clinic, Ohio.
| | - C B Bayart
- Department of Pediatric Dermatology, Cincinnati Children's Hospital Medical Center, Ohio.
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14
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Posso-Osorio I, Vargas-Potes CJ, Mejía M, Cañas CA. Eosinophil-related diseases during treatment with glucagon-like peptide one receptor (GLP-1 RA): a case report and review of the literature. Clin Rheumatol 2023; 42:2501-2506. [PMID: 37199890 PMCID: PMC10412476 DOI: 10.1007/s10067-023-06612-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/14/2023] [Accepted: 04/21/2023] [Indexed: 05/19/2023]
Abstract
Glucagon-like peptide one-receptor agonists (GLP-1 RA) are drugs that differ in their pharmacological composition and homology to human GLP-1 and are used most frequently for the treatment of type 2 diabetes and weight loss. There are isolated reports of eosinophilic adverse reactions associated with GLP-1 RA. We present the case of a 42-year-old female patient who, after starting weekly subcutaneous semaglutide, developed eosinophilic fasciitis with favorable clinical evolution after the discontinuation of semaglutide and the initiation of immunosuppression. A review of the eosinophilic adverse events that have been previously reported with GLP-1 RA is provided.
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Affiliation(s)
- Iván Posso-Osorio
- Universidad Icesi, Facultad de Ciencias de la Salud, Cali, 760031, Colombia
- Unit of Rheumatology, Fundación Valle del Lili, Unidad de Reumatología, Cali, 760031, Colombia
- Universidad Icesi, CIRAT: Centro de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Cali, 760031, Colombia
| | | | - Mauricio Mejía
- Fundación Valle del Lili, Unidad de Radiología, Cali, 760031, Colombia
| | - Carlos A Cañas
- Universidad Icesi, Facultad de Ciencias de la Salud, Cali, 760031, Colombia.
- Unit of Rheumatology, Fundación Valle del Lili, Unidad de Reumatología, Cali, 760031, Colombia.
- Universidad Icesi, CIRAT: Centro de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Cali, 760031, Colombia.
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15
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Wosiak A, Biernacka-Zielińska M, Roszkiewicz J, Smolewska E. Diffuse fasciitis with eosinophilia in boys: a case-based review. Rheumatol Int 2023; 43:1755-1764. [PMID: 37316632 PMCID: PMC10348932 DOI: 10.1007/s00296-023-05362-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/05/2023] [Indexed: 06/16/2023]
Abstract
Diffuse fasciitis with eosinophilia (EF) is a rare condition classified as a part of the connective tissue disorders. The clinical presentation of this condition can be diverse, however the main symptoms include symmetrical swelling and hardening of distal parts of limbs accompanied by peripheral eosinophilia. The diagnostic criteria are not specified. In inconclusions cases Magnetic Resonance Imaging (MRI) and skin to muscle biopsy may be useful. The pathogenesis and ethiology remain unknown, but extensive physical exertion, certain infectious factors, such as Borrelia burgdorferi, or medications may serve as a trigger. EF affects equally women and men, mainly in their middle age, however the disease can occur at any age. The standard therapy contents gluccocorticosteroids. As a second-line treatment, methotrexate is usually chosen. In this article we compare world reports of EF in paediatric patients with the cases of two adolescent male patients recently hospitalized in the Department of Paediatric Rheumatology.
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Affiliation(s)
- Agnieszka Wosiak
- Department of Paediatric Cardiology and Rheumatology, Central Clinical Hospital of the Medical University of Lodz, 36/50 Sporna St., 91-738, Lodz, Poland.
| | - Małgorzata Biernacka-Zielińska
- Department of Paediatric Cardiology and Rheumatology, Central Clinical Hospital of the Medical University of Lodz, 36/50 Sporna St., 91-738, Lodz, Poland
| | - Justyna Roszkiewicz
- Department of Paediatric Cardiology and Rheumatology, Central Clinical Hospital of the Medical University of Lodz, 36/50 Sporna St., 91-738, Lodz, Poland
| | - Elżbieta Smolewska
- Department of Paediatric Cardiology and Rheumatology, Central Clinical Hospital of the Medical University of Lodz, 36/50 Sporna St., 91-738, Lodz, Poland
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16
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Fermon C, Lessard LER, Fenouil T, Meyer A, Faruch-Bilfeld M, Robert M, Landel V, Hot A, Authier FJ, Streichenberger N, Gallay L. Revisiting idiopathic eosinophilic myositis: towards a clinical-pathological continuum from the muscle to the fascia and skin. Rheumatology (Oxford) 2023; 62:2220-2229. [PMID: 36200845 PMCID: PMC10234208 DOI: 10.1093/rheumatology/keac556] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/14/2022] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVES Idiopathic inflammatory myopathies are mainly defined by inflammatory infiltrates within the muscle (lymphocytes and macrophages). Eosinophil muscle infiltration has been described in idiopathic eosinophilic myositis (IEM) and rarely in EF. This study aimed to further delineate the nosological frame of idiopathic eosinophil muscle infiltration through the exhaustive analysis of IEM and EF patients. METHODS This multicentre retrospective case series included IEM patients diagnosed between 2000 and 2022. IEM inclusion criteria were eosinophilic muscle infiltration with myositis pathological features, after the exclusion of differential diagnoses. An additional group of EF patients diagnosed between 2016 and 2022 was constituted. Inclusion criteria were an EF diagnosis and fascia thickening with inflammatory infiltrate. RESULTS A total of 20 IEM cases and 10 EF cases were included. The median (interquartile range) age at diagnosis was 65 (49-70) years; there were 18 males. Data analysis delineated four subgroups: focal EM (FEM, n = 3), diffuse EM (DEM, n = 6), eosinophilic myofasciitis (EMF, n = 11) and EF (n = 10). FEM represented a limited and benign form of myositis. DEM cases presented objective muscle impairment with eosinophilic muscle infiltration. EMF patients presented subjective muscle impairment (myalgia, 55%), fasciitis (on histology and/or imaging), eosinophilic muscle infiltration and frequent hypereosinophilia (55%). EF patients presented myalgia (50%), muscle lesions on histology with fascia-restricted inflammatory infiltrates with (60%) or without (40%) eosinophils. CONCLUSIONS The analysis of IEM and EF patient characteristics delineates four subgroups (FEM, DEM, EMF and EF) in terms of clinical, laboratory, imaging, pathological and outcome specificities, and proposes an adapted diagnostic and care management approach.
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Affiliation(s)
- Cécile Fermon
- Service de Médecine Interne, Centre Hospitalier Universitaire Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Lola E R Lessard
- Service d’Electroneuromyographie et Pathologies Neuromusculaires, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
- Laboratoire Physiopathologie et Génétique du Neurone et du Muscle (PGNM), CNRS UMR5261—INSERM U1315, Institut NeuroMyoGène—Université Claude Bernard Lyon 1, Lyon, France
| | - Tanguy Fenouil
- Service de Cytologie et d'Anatomie Pathologique, Département de Neuropathologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France
| | - Alain Meyer
- Centre de Reference des Maladies Autoimmunes Rares, Service de Rhumatologie, Exploration Fonctionnelle Musculaires, Service de Physiologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- EA3072 Université de Strasbourg, Strasbourg, France
| | - Marie Faruch-Bilfeld
- Service d’Imagerie, Centre Hospitalier Universitaire de Toulouse, Hôpital Pierre Paul Riquet, Toulouse, France
| | - Marie Robert
- Service de Médecine Interne, Centre Hospitalier Universitaire Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Verena Landel
- Direction de la Recherche en Santé, Hospices Civils de Lyon, Lyon, France
| | - Arnaud Hot
- Service de Médecine Interne, Centre Hospitalier Universitaire Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - François-Jérôme Authier
- Université Paris Est-Créteil, INSERM, IMRB U955, Team Relaix, Créteil, France
- Centre de Référence « Nord-Est-Ile de France » pour les Pathologies Neuromusculaires, FILNEMUS, Paris, France
- UH Histologie/Département de Pathologie, Centre Hospitalier Universitaire Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | | | - Laure Gallay
- Correspondence to: Laure Gallay, Service de Médecine Interne du Pr Arnaud Hot, Hôpital Edouard Herriot, 5 Place d’Arsonval, F-69003 Lyon, France. E-mail:
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17
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Li X, Ma DL. Groove sign in eosinophilic fasciitis. Med J Aust 2023. [PMID: 37211616 DOI: 10.5694/mja2.51983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/11/2023] [Accepted: 02/24/2023] [Indexed: 05/23/2023]
Affiliation(s)
- Xingyu Li
- Peking Union Medical College Hospital, Dongcheng-Qu, China
| | - Dong-Lai Ma
- Peking Union Medical College Hospital, Dongcheng-Qu, China
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18
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Ma X, Gao H, Xu L, Bi Z, Ji S, Bu B. Increased expression of cell adhesion molecules in myofasciitis. Front Neurol 2023; 14:1113404. [PMID: 37228411 PMCID: PMC10203699 DOI: 10.3389/fneur.2023.1113404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/20/2023] [Indexed: 05/27/2023] Open
Abstract
Background Myofasciitis is a heterogeneous group of diseases pathologically characterized by inflammatory cell infiltration into the fascia. Endothelial activation plays a critical role in the pathogenesis of the inflammatory response. However, the expression of cellular adhesion molecules (CAMs) in myofasciitis has not been investigated. Methods Data on clinical features, thigh magnetic resonance imaging, and muscle pathology were collected from five patients with myofasciitis. Immunohistochemical (IHC) staining and Western blot (WB) of the muscle biopsies from patients and healthy controls were performed. Results Increased levels of serum pro-inflammatory cytokines, including IL-6, TNF-α, and IL-2R, were detected in four patients. IHC staining and WB indicated significantly increased expression of cell adhesion molecules in blood vessels or inflammatory cells within the perimysium in muscle and fascia tissues of patients with myofasciitis compared to controls. Conclusion The up-regulation of CAMs in myofasciitis indicates endothelial activation, which may be potential therapy targets for the treatment of myofasciitis.
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Affiliation(s)
- Xue Ma
- Department of Neurology, Air Force Medical University Tangdu Hospital, Xi’an, China
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huajie Gao
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Xu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhuajin Bi
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Suqiong Ji
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bitao Bu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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19
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Lan TY, Wang ZH, Kong WP, Wang JP, Zhang N, Jin DE, Luo J, Tao QW, Yan ZR. Eosinophilic fasciitis difficult to differentiate from scleroderma: A case report. World J Clin Cases 2023; 11:3092-3098. [PMID: 37215414 PMCID: PMC10198086 DOI: 10.12998/wjcc.v11.i13.3092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 03/02/2023] [Accepted: 03/27/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Eosinophilic fasciitis (EF) is a rare connective tissue disease that can cause swelling and sclerosis of the extremities, and special attention is needed to differentiate EF from systemic sclerosis. Misdiagnosis or omission markedly delays treatment of EF, and severe skin sclerosis in advanced stages can cause joint contracture and tendon retraction, worsening the patient's prognosis and quality of life.
CASE SUMMARY We report a case of EF in a young woman diagnosed by tissue biopsy, confirming the difficulty of differential diagnosis with scleroderma.
CONCLUSION Focusing on skin manifestations, completing tissue biopsy and radiography can help diagnose EF effectively. Clinicians should enhance their understanding of the differences between EF and scleroderma, and early diagnosis and standardized treatment can improve the prognosis of patients with EF.
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Affiliation(s)
- Tian-Yi Lan
- Graduate College, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Zi-Han Wang
- Graduate College, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Wei-Ping Kong
- Traditional Chinese Medicine Department of Rheumatism, China-Japan Friendship Hospital, Beijing 100029, China
| | - Jin-Ping Wang
- Traditional Chinese Medicine Department of Rheumatism, China-Japan Friendship Hospital, Beijing 100029, China
| | - Nan Zhang
- Traditional Chinese Medicine Department of Rheumatism, China-Japan Friendship Hospital, Beijing 100029, China
| | - Di-Er Jin
- Traditional Chinese Medicine Department of Rheumatism, China-Japan Friendship Hospital, Beijing 100029, China
| | - Jing Luo
- Traditional Chinese Medicine Department of Rheumatism, China-Japan Friendship Hospital, Beijing 100029, China
| | - Qing-Wen Tao
- Traditional Chinese Medicine Department of Rheumatism, China-Japan Friendship Hospital, Beijing 100029, China
| | - Ze-Ran Yan
- Traditional Chinese Medicine Department of Rheumatism, China-Japan Friendship Hospital, Beijing 100029, China
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20
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Chen Z, Wasti B, Shang Y, Jia A, Xiang X, Ouyang R. Clinical characteristics and risk factors of patients with eosinophilic fasciitis associated with pleural effusion. Sci Rep 2023; 13:5452. [PMID: 37012347 PMCID: PMC10070614 DOI: 10.1038/s41598-023-32678-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/31/2023] [Indexed: 04/05/2023] Open
Abstract
To investigate the risk factors of eosinophilic fasciitis (EF) associated with pleural effusion (PE). A retrospective analysis was performed on 22 patients with EF diagnosed by skin biopsy in our hospital, and they were divided into EF-PE and EF according to chest computed tomography examination. The clinical characteristics, clinical manifestations, comorbidities and laboratory test indicators of the two groups were collected and compared, and the risk factors for occurring PE in patients with EF were determined by multivariate logistic regression analysis. Among 22 patients with EF, 8 had PE. The age, course of disease, incidence of fever, weight loss, cough and shortness of breath, pulmonary infection, hypothyroidism, hydronephrosis and kidney stone, swelling rate of small vascular endothelial cells, consolidation shadows, C-reactive protein and thyroid stimulating hormone in EF-PE group were higher than those in EF group, while free triiodothyronine and thyroxine were lower than those in EF group. Age, fever, shortness of breath, C-reactive protein, ESR, thyroid stimulating hormone, pulmonary infection, hypothyroidism, hydronephrosis, kidney stones, swollen small vascular endothelial cells and chest CT consolidation shadows were identified as risk factors for happening PE in patients with EF, while free triiodothyronine and free thyroxine were identified as protective factors against PE in patients with EF. The incidence of EF-PE was 36.36% in this study. Advanced age, high C-reactive protein, ESR, thyroid stimulating hormone, incidence of fever, shortness of breath, pulmonary infection, hydronephrosis, kidney stones, swollen small vascular endothelial cells, chest CT consolidation shadows, and low free triiodothyronine and thyroxine suggest that patients with EF are significantly at increased risk of PE.
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Affiliation(s)
- Zhifeng Chen
- Department of Respiratory Medicine, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China
| | - Binaya Wasti
- Department of Respiratory Medicine, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China
| | - Yulin Shang
- Ophthalmology and Otorhinolaryngology, Zigui County Traditional Chinese Medicine Hospital, 30 Pinghu Avenue, Zigui, 443600, Hubei, China
| | - Aijun Jia
- Department of the Third Emergency of Yuelushan Hospital District, Hunan Provincial People's Hospital, No.90 Pingchuan Road, Changsha, 410006, Hunan, China
| | - Xudong Xiang
- Department of Emergency, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China
| | - Ruoyun Ouyang
- Department of Respiratory Medicine, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China.
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21
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Kim J, Lee LH. Diagnostic Utility of Magnetic Resonance Imaging in Eosinophilic Fasciitis: A Case Report and Review of Literature. Cureus 2023; 15:e37899. [PMID: 37214068 PMCID: PMC10199750 DOI: 10.7759/cureus.37899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2023] [Indexed: 05/23/2023] Open
Abstract
Eosinophilic fasciitis (EF), also known as Shulman syndrome, is a rare scleroderma-like disorder that is characterized by an acute onset of induration, swelling, erythema, and tenderness of the skin and deep fascia, often affecting all four limbs. We report a case of eosinophilic fasciitis in a 51-year-old female patient, whose diagnosis of EF was made based on the findings from clinical evaluation and magnetic resonance imaging (MRI) but without skin biopsy. She was treated with a combination therapy of prednisolone and methotrexate, and her response to therapy was assessed via clinical assessment and MRI. MRI may be a useful non-invasive diagnostic tool for not only supporting but also confirming the clinical diagnosis of EF when a skin-to-muscle biopsy is not available or cannot be performed, as well as for monitoring disease activity and response to therapy. Further prospective studies should be conducted to evaluate the precise sensitivity and specificity of MRI in diagnosing EF and also to create more structured protocols to guide the diagnosis and management of EF.
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Affiliation(s)
- Jiwon Kim
- General Medicine, Goulburn Valley Health, Shepparton, AUS
| | - Lit Hiang Lee
- General Medicine, Goulburn Valley Health, Shepparton, AUS
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22
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Macklin M, Yadav S, Jan R, Reid P. Checkpoint Inhibitor-Associated Scleroderma and Scleroderma Mimics. Pharmaceuticals (Basel) 2023; 16:259. [PMID: 37259404 PMCID: PMC9962184 DOI: 10.3390/ph16020259] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 10/28/2023] Open
Abstract
Immune checkpoint inhibitors (ICI) are the standard of care for various malignancies and have been associated with a wide spectrum of complications that are phenotypically akin to primary autoimmune diseases. While the literature on these toxicities is growing, there is a paucity of data regarding ICI-associated scleroderma which can carry significant morbidity and limit the ability to continue effective ICI therapy. Our review aimed to analyze the current literature on ICI-associated systemic scleroderma (ICI-SSc) and key scleroderma mimics. Cases of ICI-SSc had notable differences from primary SSc, such as fewer vascular features and less seropositivity (such as scleroderma-specific antibodies and antinuclear antibodies). We found that patients with a diagnosis of SSc prior to the start of ICI can also experience flares of pre-existing disease after ICI treatment used for their cancer. Regarding scleroderma mimics, several cases of ICI-eosinophilic fasciitis have also been described with variable clinical presentations and courses. We found no cases of scleroderma mimics: ICI-scleromyxedema or ICI-scleroedema. There is a critical need for multi-institutional efforts to collaborate on developing a patient database and conducting robust, prospective research on ICI-scleroderma. This will ultimately facilitate more effective clinical evaluations and management for ICI-scleroderma.
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Affiliation(s)
- Michael Macklin
- Section of Rheumatology, Department of Medicine, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Sudeep Yadav
- Section of Rheumatology, Department of Medicine, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Reem Jan
- Section of Rheumatology, Department of Medicine, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Pankti Reid
- Section of Rheumatology, Department of Medicine, University of Chicago Medical Center, Chicago, IL 60637, USA
- Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago Medical Center, Chicago, IL 60637, USA
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23
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LOPES AR, BRANCO LC, PEREIRA C, COELHO M, PINELO E. Shulman Syndrome: a clinical case, two rare associations. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2022. [DOI: 10.23736/s0393-3660.21.04622-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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24
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Camard M, Maisonobe T, Flamarion E. The groove sign in eosinophilic fasciitis. Clin Rheumatol 2022; 41:3919-3920. [PMID: 35907103 DOI: 10.1007/s10067-022-06311-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/13/2022] [Accepted: 07/16/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Marion Camard
- Department of Internal Medicine, Hôpital Européen Georges Pompidou, AP-HP, Centre-Université Paris Cité, Paris, France.
| | - Thierry Maisonobe
- Department of Neurophysiology, AP-HP, Sorbonne Université, Hôpital Pitié Salpêtrière, Paris, France
| | - Edouard Flamarion
- Department of Internal Medicine, Hôpital Européen Georges Pompidou, AP-HP, Centre-Université Paris Cité, Paris, France
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25
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Anadure R, Shankar S, Mohimen A, Pemmaraju A, Kalita J. An unusual case of eosinophilia, myalgia and skin contractures: Shulman's disease revisited. Med J Armed Forces India 2022; 78:S273-S276. [PMID: 36147388 PMCID: PMC9485746 DOI: 10.1016/j.mjafi.2019.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 12/29/2019] [Indexed: 10/24/2022] Open
Abstract
Shulman's disease (eosinophilic fasciitis) is a very rare autoimmune disorder with an unknown etiopathogenesis. During the initial period of disease, it usually causes limb and trunk edema followed by collagenous thickening of the subcutaneous fascia. Eosinophilia is a predominant laboratory finding during the initial phase of the disease and less prominent in the later phases. Patients may also present with arthritis, myositis, peripheral neuropathy, and rarely pleuropericarditis. Here, we are reporting a case of eosinophilic fasciitis presenting with vague constitutional symptoms, fever, and peripheral blood eosinophilia followed by rapidly evolving skin tightening with joint contractures and muscle stiffness, which misled the treating team toward Scleroderma and its overlap syndromes. The diagnosis was finally clinched by a full-thickness skin biopsy along with underlying fascia and muscle tissue from an effected area, with a gratifying treatment response to standard immune suppression.
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Affiliation(s)
- R.K. Anadure
- Senior Advisor (Neurology), Command Hospital (Air Force), Bengaluru, India
| | - S. Shankar
- Professor & Head, Department of Internal Medicine, Armed Forces Medical College, Pune 411040, India
| | - Aneesh Mohimen
- Classified Specialist (Radiology), Command Hospital (Air Force), Bengaluru, India
| | - Arpitha Pemmaraju
- Classified Specialist (Pathology), Command Hospital (Air Force), Bengaluru, India
| | - Jitumani Kalita
- Senior Resident (Medicine), Command Hospital (Air Force), Bengaluru, India
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26
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Chaigne B, Tieu A, Beeker N, Zuelgaray E, Bouaziz JD, Sène D, Dupin N, Mouthon L. Cluster analysis reveals eosinophilia and fibrosis as poor prognostic markers in 128 patients with eosinophilic fasciitis. J Am Acad Dermatol 2022; 87:997-1005. [PMID: 35995088 DOI: 10.1016/j.jaad.2022.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/11/2022] [Accepted: 08/09/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Eosinophilic fasciitis (EF) is an extremely rare disease with polymorphic presentation and prognosis. OBJECTIVE To further investigate EF features. METHODS We performed a retrospective multicentre study of EF patients from 2013 to 2019, clustered patients using multivariate correspondence analysis (MCA) and sought prognosis factors. RESULTS One hundred twenty-eight patients were included. Sixty-nine (50%) patients had skin sclerosis and eosinophil count was increased in 71 (55%) patients. MCA identified 3 clusters: a "mild", a "late-onset and hypereosinophilic" and a "fibrotic" cluster. Of 109 patients followed-up for more than one year, 49 (45%) presented a relapse and 48 (44%) had sequelae. Multivariate analysis revealed that eosinophilia (hazard ratio (HR)=1.56; p=0.02) and fibrosis (HR=4.02; p=0.002) were predictive factors of relapse, whereas edema (odds ratio (OR)=0.31; p=0.03), relapse (OR=3.00; p=0.04) and fibrosis (OR=1) were predictive factors of sequelae. Following relapse, treatment modifications consisted of an increase in glucocorticoids in 40 (82%) patients and addition of methotrexate in 31 (63%) patients. These modifications led to clinical improvement and glucocorticoid withdrawal in 37 (76%) and 22 (45%) patients, respectfully. LIMITATIONS Retrospective study. CONCLUSION EF patients can be divided into three homogenous clusters, which, along with fibrosis and eosinophilia, are prognosis factors of relapse and sequelae.
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Affiliation(s)
- Benjamin Chaigne
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France; APHP-CUP, Hôpital Cochin, Université de Paris, Paris, France.
| | - Ashley Tieu
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France; APHP-CUP, Hôpital Cochin, Université de Paris, Paris, France
| | | | - Elina Zuelgaray
- Service de Dermatologie, Hôpital Saint-Louis, Université de Paris, Paris, France
| | - Jean-David Bouaziz
- Service de Dermatologie, Hôpital Saint-Louis, Université de Paris, Paris, France
| | - Damien Sène
- Département de Médecine Interne et d'Immunologie clinique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Nicolas Dupin
- APHP-CUP, Hôpital Cochin, Université de Paris, Paris, France; Service de Dermatologie, Hôpital Cochin, Université de Paris, Paris, France
| | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France; APHP-CUP, Hôpital Cochin, Université de Paris, Paris, France
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27
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Brandy-García A, Fernández Aguado S, Pampín-Sánchez R. Tocilizumab en el tratamiento de la fascitis eosinofílica: presentación de un caso y revisión de la literatura. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2021.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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28
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Abstract
Palmar fasciitis and polyarthritis syndrome (PFPAS) is a rare paraneoplastic rheumatic disease with characteristic features. We herein report a 77-year-old man with lung adenocarcinoma and contralateral pulmonary metastasis receiving chemotherapy who presented with progressive symmetrical flexion contractures associated with palmar fascial thickening and arthritis of both hands and shoulders. He was diagnosed with PFPAS as paraneoplastic manifestations. Salazosulfapyridine was not effective, but 15 mg/day of oral prednisolone improved his symptoms. Physicians should consider PFPAS and rule out malignancy in patients with arthritis in the extremities and flexion contractures associated with palmar fascial thickening.
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Affiliation(s)
- Hisatoshi Okumura
- Division of General Internal Medicine, North Medical Center Kyoto Prefectural University of Medicine, Japan
| | - Hidetaka Ishino
- Division of General Internal Medicine, North Medical Center Kyoto Prefectural University of Medicine, Japan
| | - Daisuke Yokoi
- Division of General Internal Medicine, North Medical Center Kyoto Prefectural University of Medicine, Japan
| | - Masami Matsumura
- Division of General Internal Medicine, Jichi Medical University, Japan
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Blackmond N, Kanke J, Brown K, Weitzman R. Eosinophilic Fasciitis: A Rare and Challenging Diagnosis in a Free Clinic Setting. Cureus 2022; 14:e25668. [PMID: 35812539 PMCID: PMC9255255 DOI: 10.7759/cureus.25668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2022] [Indexed: 11/17/2022] Open
Abstract
Eosinophilic fasciitis (EF) is a rare ailment that affects the immune system. Due to the rarity of this condition, there are few clear diagnostic criteria for clinicians to focus on. This may lead to significant delays in reaching a diagnosis and offering proper treatment, and patients may end up seeing multiple different specialists. This is especially true in a free clinic setting where continuity of care, follow-up, and specialist access are usually lacking. In this report, we describe a case of a 24-year-old white male who presented with sudden onset of redness, swelling, burning, and pain in the bilateral upper and lower extremities. Through arduous workup and testing, he was found to have increased eosinophils in peripheral blood, elevated levels of white blood cell count, increased C-reactive protein, and pathological changes in the tissue showing eosinophil and lymphocyte infiltration. We shed light on the relative rarity of this condition and its similar clinical characteristics to various dermatological/rheumatological disease processes. We also highlight how a free clinic can provide high-quality healthcare to bridge gaps in access to care by providing high-quality and broad specialist access while ensuring continuity of care.
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Naschitz JE. Clinical guide to eosinophilic fasciitis: straddling dermatology and rheumatology. Expert Rev Clin Immunol 2022; 18:649-651. [PMID: 35575016 DOI: 10.1080/1744666x.2022.2078309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Jochanan E Naschitz
- Bait Balev Nesher and the Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
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31
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Yamazaki H, Matsui N, Takamatsu N, Yoshida T, Fukushima K, Takata T, Osaki Y, Tanaka K, Kubo Y, Izumi Y. Application of ultrasound in a case of eosinophilic fasciitis mimicking stiff-person syndrome. Neuromuscul Disord 2022; 32:590-593. [DOI: 10.1016/j.nmd.2022.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 04/21/2022] [Accepted: 05/16/2022] [Indexed: 11/16/2022]
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32
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Haroon A, Tadros J, Smith EH. Eosinophilic Fasciitis with Concurrent Necrobiotic Granulomatous Dermatitis Related to Checkpoint Inhibition Therapy. JOURNAL OF IMMUNOTHERAPY AND PRECISION ONCOLOGY 2022; 5:48-51. [PMID: 35664087 PMCID: PMC9153248 DOI: 10.36401/jipo-21-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 12/02/2022]
Abstract
Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapeutics. However, loss of physiologic tolerance in few cases has triggered rare and novel immune-related adverse events (irAEs). Eosinophilic fasciitis, an infrequently reported diffuse scleroderma-like entity, has been associated with ICI therapy. We report a case of a patient with metastatic melanoma treated with nivolumab who developed eosinophilic fasciitis with concurrent granulomatous dermatitis and lymphadenitis, the latter of which mimicked melanoma recurrence radiographically. Furthermore, this patient had a severe presentation that subsequently proved to be treatment-resistant to both corticosteroid and steroid-sparing therapies. To our knowledge, eosinophilic fasciitis has not been reported concurrently with granulomatous dermatitis in literature. We provide a narrative of this case and a review of therapeutic approaches for severe or refractory irAEs. With the increasing popularity of ICI therapy, we believe it is essential for clinicians to identify novel irAEs and be aware of treatments as late recognition could prove fatal.
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Affiliation(s)
- Adeeb Haroon
- Department of Dermatology, University of Missouri, Columbia, MO, USA
| | - Joseph Tadros
- Department of Dermatology, University of Missouri, Columbia, MO, USA
| | - Emily H. Smith
- Department of Dermatology, University of Missouri, Columbia, MO, USA
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Brandy-García A, Fernández S, Pampín-Sánchez R. Tocilizumab in the treatment of eosinophilic fasciitis: Case report and literature review. Rev Clin Esp 2022; 222:440-442. [DOI: 10.1016/j.rceng.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 12/02/2021] [Indexed: 10/18/2022]
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Watanabe S, Kondo M, Ichishi M, Hayashi A, Matsushima Y, Hirokawa Y, Habe K, Yamanaka K. Eosinophilic fasciitis induced by a game of drumming probably via type 2 innate immunity. Int J Rheum Dis 2022; 25:364-366. [PMID: 35023307 DOI: 10.1111/1756-185x.14284] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/25/2021] [Accepted: 12/30/2021] [Indexed: 12/01/2022]
Abstract
We report a case of eosinophilic fasciitis triggered by strenuous physical activity, which did not relapse during the follow-up period. We ascertained that interleukin-33 (IL-33) was released from the vascular endothelial cells after intense exercise, inducing type 2 innate lymphocytes (ILC2) and causing fasciitis. A healthy woman experienced itching on both limbs a few hours after a game of drumming. Her hand, knee joints, and legs gradually swelled up with groove signs along the superficial veins. White blood cell and eosinophil counts were significantly elevated. Magnetic resonance imaging revealed a high signal at the fascia on both lower limbs. Histopathological findings of the left lower limb tissue specimen showed edematous fascia with eosinophils. No relapse of eosinophilic fasciitis was observed after finishing treatment with prednisolone. Immunological staining for IL-4, IL-5, IL-33, tumor necrosis factor-α, and interferon-γ was performed on the fascial tissue. Both IL-4 and IL-5 were stained on the lymphocytes at the muscle and fascia levels; however, CD3 and CD4 were unstained in these cells, suggesting that those cells were ILC2. Tumor necrosis factor-α and interferon-γ were unstained. Vascular endothelial cells in the fascia strongly expressed IL-33. Eosinophilic fasciitis may be associated with type 2 immunity triggered by IL-33 in the current case.
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Affiliation(s)
- Seimi Watanabe
- Department of Dermatology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Makoto Kondo
- Department of Dermatology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Masako Ichishi
- Department of Oncologic Pathology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Akinobu Hayashi
- Department of Oncologic Pathology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yoshiaki Matsushima
- Department of Dermatology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yoshifumi Hirokawa
- Department of Oncologic Pathology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Koji Habe
- Department of Dermatology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Keiichi Yamanaka
- Department of Dermatology, Mie University Graduate School of Medicine, Tsu, Japan
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Amrane K, Le Meur C, Thuillier P, Alemany P, Niel C, Renault D, Abgral R. Case report: Eosinophilic fasciitis induced by pembrolizumab with high FDG uptake on 18F-FDG-PET/CT. Front Med (Lausanne) 2022; 9:1078560. [PMID: 36606046 PMCID: PMC9807755 DOI: 10.3389/fmed.2022.1078560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
Eosinophilic fasciitis (EF) is a rare connective tissue disorder causing inflammation and fibrosing of fascia. In this study, we present a very rare case of an immune checkpoint inhibitor (ICI)-induced EF revealed by 18F-fluorodesoxyglucose positron emission tomography (FDG-PET/CT) 20 months after the initiation of Pembrolizumab treatment of a relapsed non-small cell lung cancer (NSCLC). This study presents a 52-year-old Caucasian woman clinically presenting asthenia, inflammatory muscle, and joint pain associated with subcutaneous nodules and symmetrical edema of the lower limbs. Iterative 18FDG-PET/CT scans allow us to guide the therapeutic strategy due to this atypical ICI adverse event.
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Affiliation(s)
- Karim Amrane
- Department of Oncology, Centre Hospitalier des Pays de Morlaix, Morlaix, France.,Institut National de la Santé et de la Recherche Médicale UMR 1227, Lymphocytes B et Autoimmunité, Univ. Brest, Institut National de la Santé et de la Recherche Médicale, LabEx IGO, Brest, France
| | - Coline Le Meur
- Department of Oncology, Centre Hospitalier des Pays de Morlaix, Morlaix, France
| | - Philippe Thuillier
- Institut National de la Santé et de la Recherche Médicale UMR 1304 GETBO, University of Western Brittany, Brest, France.,Department of Endocrinology, University Hospital of Brest, Brest, France
| | - Pierre Alemany
- Department of Pathology, Ouest Pathologie, Brest, France
| | - Clémence Niel
- Department of Pneumology, Centre Hospitalier des Pays de Morlaix, Morlaix, France
| | - David Renault
- Department of Pneumology, Centre Hospitalier des Pays de Morlaix, Morlaix, France
| | - Ronan Abgral
- Department of Endocrinology, University Hospital of Brest, Brest, France.,Department of Nuclear Medicine, University Hospital of Brest, Brest, France
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Primitivo A, Madeira N, Lopez D, Afonso D. Eosinophilic fasciitis (Shulman disease) with clinical, imaging and pathological correlation. BMJ Case Rep 2021; 14:e246151. [PMID: 34969795 PMCID: PMC8719132 DOI: 10.1136/bcr-2021-246151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2021] [Indexed: 11/04/2022] Open
Abstract
Eosinophilic fasciitis (EF) is a rare subacute fibrosing disorder of unknown aetiology, characterised by thickening of the muscular fascia and subcutaneous tissue, leading to swelling of limbs and trunk and sparing fingers and toes. Eosinophilic infiltration and degranulation may prompt tissue damage and consequent fibrosis due to the accumulation of collagen and extracellular matrix proteins. MRI is the best imaging modality for diagnosis, depicting fascial thickening and enhancement. MRI may also have a significant role in excluding alternative diagnosis and guiding the skin-muscle biopsy.We report a case of EF with clinical and pathological correlation, highlighting the diagnostic value of MRI for early diagnosis and further treatment.
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Affiliation(s)
- Ana Primitivo
- Radiology, Hospital Beatriz Ângelo, Loures, Portugal
| | - Nathalie Madeira
- Reumatology, Instituto Português de Reumatologia, Lisboa, Lisboa, Portugal
| | - Dolores Lopez
- Anatomical Pathology, Centro Hospitalar Lisboa Norte EPE, Lisboa, Lisboa, Portugal
| | - Diana Afonso
- Department of Radiology, Hospital da Luz, Lisboa, Lisboa, Portugal
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Tognetti L, Marrocco C, Carraro A, Conticini E, Habougit C, Mariotti G, Cinotti E, Perrot JL, Rubegni P. UVA-1 phototherapy as adjuvant treatment for eosinophilic fasciitis: in vitro and in vivo functional characterization. Int J Dermatol 2021; 61:718-726. [PMID: 34881449 PMCID: PMC9299925 DOI: 10.1111/ijd.16003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/21/2021] [Accepted: 11/10/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Eosinophilic fasciitis (EF) is a rare autoimmune disease causing progressive induration of dermal, hypodermal, and muscularis fascia. The exact pathogenesis is yet to be fully understood, and a validated therapy protocol still lacks. We here aimed to realize a clinical-functional characterization of these patients. MATERIALS AND METHODS A total of eight patients (five males, 45 years average) were treated with adjuvant high-dose UVA-1 phototherapy (90 J/cm), after having received the standard systemic immunosuppressive protocol (oral methylprednisolone switched to methotrexate). Body lesion mapping, Localized Scleroderma Assessment Tool (LoSCAT), Dermatology Life Quality Index (DLQI), High-Resolution Ultrasound (HRUS) (13-17MHz), and ultra HRUS (55-70 MHz) were performed at each examination time taking specific anatomical points. Gene expression analysis at a molecular level and in vitro UVA-1 irradiation was realized on lesional fibroblasts primary cultures. RESULTS The LoSCAT and the DLQI showed to decrease significantly starting from the last UVA-1 session. A significant reduction in muscularis fascia thickness (-50% on average) was estimated starting from 3 months after the last UVA-1 session and maintained up to 12 months follow-up. Tissues was detected by HRUS. The UVA-1 in vitro irradiation of lesional skin sites cells appeared not to affect their viability. Molecular genes analysis revealed a significant reduction of IL-1ß and of TGF-ß genes after phototherapy, while MMPs 1,2,9 gene expression was enhanced. COMMENT These preliminary in vivo and in vitro findings suggest that UVA-1 phototherapy is a safe and useful adjuvant therapy able to elicit anti-inflammatory effects and stimulate tissue matrix digestion and remodeling at lesional sites.
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Affiliation(s)
- Linda Tognetti
- Dermatology Unit and Skin Bank Unit, Department of Clinical, Surgical and Neuro-sciences, University of Siena, Italy
| | - Camilla Marrocco
- Dermatology Unit and Skin Bank Unit, Department of Clinical, Surgical and Neuro-sciences, University of Siena, Italy
| | - Andrea Carraro
- Dermatology Unit and Skin Bank Unit, Department of Clinical, Surgical and Neuro-sciences, University of Siena, Italy
| | - Edoardo Conticini
- Rheumatology Unit, Department of Clinical, Surgical and Neuro-sciences, University of Siena, Italy
| | - Cyril Habougit
- Department of Pathology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Giancarlo Mariotti
- Dermatology Unit and Skin Bank Unit, Department of Clinical, Surgical and Neuro-sciences, University of Siena, Italy
| | - Elisa Cinotti
- Dermatology Unit and Skin Bank Unit, Department of Clinical, Surgical and Neuro-sciences, University of Siena, Italy
| | - Jean Luc Perrot
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Pietro Rubegni
- Dermatology Unit and Skin Bank Unit, Department of Clinical, Surgical and Neuro-sciences, University of Siena, Italy
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Gutierrez D, Peterson EL, Kim RH, Franks AG, Lo Sicco KI. Eosinophilic Fasciitis With Concomitant Morphea Profunda Treated With Intravenous Immunoglobulin. J Clin Rheumatol 2021; 27:S500-S501. [PMID: 31693648 DOI: 10.1097/rhu.0000000000001158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Daniel Gutierrez
- The Ronald O. Perelman Department of Dermatology New York University School of Medicine New York, NY
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Rea A, Anderson A, Moshiri A, Paulson K, Thompson JA, Kalus A. Eosinophilic fasciitis as a paraneoplastic syndrome in melanoma. JAAD Case Rep 2021; 17:49-51. [PMID: 34703864 PMCID: PMC8526906 DOI: 10.1016/j.jdcr.2021.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Andrea Rea
- Division of Dermatology, University of Washington, Seattle, Washington
| | - Alexis Anderson
- School of Medicine, University of Washington, Seattle, Washington
| | - Ata Moshiri
- Division of Dermatology, University of Washington, Seattle, Washington
| | - Kelly Paulson
- Swedish Cancer Institute Medical Oncology, Edmonds, Washington
| | - John A Thompson
- Division of Oncology, University of Washington, Seattle, Washington
| | - Andrea Kalus
- Division of Dermatology, University of Washington, Seattle, Washington
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40
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Dańczak-Pazdrowska A, Cieplewicz P, Żaba R, Adamski Z, Polańska A. Controversy around the morphea. Postepy Dermatol Alergol 2021; 38:716-720. [PMID: 34849114 PMCID: PMC8610066 DOI: 10.5114/ada.2021.106242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/23/2021] [Indexed: 11/24/2022] Open
Abstract
Morphea, also known as localized scleroderma, is a chronic, autoimmune disease of connective tissue. It is characterized by a typical clinical feature. In morphea, there is no Raynaud's phenomenon, no sclerodactyly or no ulcerations on the fingertips. Although morphea and systemic sclerosis have been perceived as separate disease entities for years, they are still confused both by patients (which is a source of unnecessary stress) and doctors. This may be due to, in part, misunderstood terminology. The controversy around morphea also concerns the division of this disease entity, including its less common subtypes, such as eosinophilic fasciitis. Discussions also revolve around the diagnostic aspects and possible treatment options. The paper attempts to present the debatable aspects regarding nomenclature, classification, diagnosis and treatment of morphea.
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Affiliation(s)
| | - Paulina Cieplewicz
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Ryszard Żaba
- Department of Dermatology and Venereology, Poznan University of Medical Sciences, Poznan, Poland
| | - Zygmunt Adamski
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Adriana Polańska
- Department of Dermatology and Venereology, Poznan University of Medical Sciences, Poznan, Poland
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41
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Furnishing Wound Repair by the Subcutaneous Fascia. Int J Mol Sci 2021; 22:ijms22169006. [PMID: 34445709 PMCID: PMC8396603 DOI: 10.3390/ijms22169006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/10/2021] [Accepted: 08/17/2021] [Indexed: 12/28/2022] Open
Abstract
Mammals rapidly heal wounds through fibrous connective tissue build up and tissue contraction. Recent findings from mouse attribute wound healing to physical mobilization of a fibroelastic connective tissue layer that resides beneath the skin, termed subcutaneous fascia or superficial fascia, into sites of injury. Fascial mobilization assembles diverse cell types and matrix components needed for rapid wound repair. These observations suggest that the factors directly affecting fascial mobility are responsible for chronic skin wounds and excessive skin scarring. In this review, we discuss the link between the fascia's unique tissue anatomy, composition, biomechanical, and rheologic properties to its ability to mobilize its tissue assemblage. Fascia is thus at the forefront of tissue pathology and a better understanding of how it is mobilized may crystallize our view of wound healing alterations during aging, diabetes, and fibrous disease and create novel therapeutic strategies for wound repair.
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42
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Boppana SH, Dulla NR, Beutler BD, Gullapalli N, Kaur R. Drug-Associated Eosinophilic Fasciitis: A Case of Eosinophilic Fasciitis Secondary to Cemiplimab Therapy. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e932888. [PMID: 34403405 PMCID: PMC8380854 DOI: 10.12659/ajcr.932888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 07/07/2021] [Accepted: 07/01/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Eosinophilic fasciitis, also known as Shulman syndrome, is a rare inflammatory condition characterized by diffuse erythema and progressive collagenous thickening of the subcutaneous fascia. The underlying cause remains to be definitively established; however, several drugs have been linked to this uncommon clinical entity. We present a rare case of eosinophilic fasciitis secondary to immune checkpoint inhibitor therapy. CASE REPORT A 72-year-old woman with metastatic cutaneous squamous cell carcinoma presented to the rheumatology clinic for evaluation of joint pain that developed 3 weeks after beginning treatment with cemiplimab. The correlation of clinical history and physical examination was most consistent with osteoarthritis. Symptoms improved after a short course of low-dose prednisone. The patient continued cemiplimab therapy for approximately 1 year and was subsequently transitioned to carboplatin and radiation therapy. However, relapse occurred shortly thereafter, and cemiplimab was restarted. Two weeks later, the patient developed severe joint pain, morning stiffness, and extensive cutaneous discoloration and induration. A skin biopsy was performed. Microscopic examination of a tissue sample showed a mononuclear infiltrate with plasma cells and eosinophils. A diagnosis of eosinophilic fasciitis was established. Cemiplimab was held and the patient was treated with hydroxychloroquine, prednisone, and sulfasalazine. Symptoms improved within 1 week. CONCLUSIONS Eosinophilic fasciitis is a rare but important adverse effect of immune checkpoint inhibitors. Individuals receiving immunotherapy should be monitored closely for symptoms of eosinophilic fasciitis, as prompt treatment is essential to prevent long-term complications.
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Affiliation(s)
- Sri Harsha Boppana
- Department of Internal Medicine, Reno School of Medicine, University of Nevada, Reno, NV, USA
| | - Nageswara Rao Dulla
- Department of Internal Medicine, Mythri Multispecialty Hospital, Guntur, India
| | - Bryce D. Beutler
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Nageshwara Gullapalli
- Department of Internal Medicine, Reno School of Medicine, University of Nevada, Reno, NV, USA
| | - Ratinder Kaur
- Department of Internal Medicine, Reno School of Medicine, University of Nevada, Reno, NV, USA
- Department of Rheumatology, Arthritis Consultants, Reno, NV, USA
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43
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Leyens J, Bender TTA, Mücke M, Stieber C, Kravchenko D, Dernbach C, Seidel MF. The combined prevalence of classified rare rheumatic diseases is almost double that of ankylosing spondylitis. Orphanet J Rare Dis 2021; 16:326. [PMID: 34294115 PMCID: PMC8296612 DOI: 10.1186/s13023-021-01945-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rare diseases (RDs) affect less than 5/10,000 people in Europe and fewer than 200,000 individuals in the United States. In rheumatology, RDs are heterogeneous and lack systemic classification. Clinical courses involve a variety of diverse symptoms, and patients may be misdiagnosed and not receive appropriate treatment. The objective of this study was to identify and classify some of the most important RDs in rheumatology. We also attempted to determine their combined prevalence to more precisely define this area of rheumatology and increase awareness of RDs in healthcare systems. We conducted a comprehensive literature search and analyzed each disease for the specified criteria, such as clinical symptoms, treatment regimens, prognoses, and point prevalences. If no epidemiological data were available, we estimated the prevalence as 1/1,000,000. The total point prevalence for all RDs in rheumatology was estimated as the sum of the individually determined prevalences. RESULTS A total of 76 syndromes and diseases were identified, including vasculitis/vasculopathy (n = 15), arthritis/arthropathy (n = 11), autoinflammatory syndromes (n = 11), myositis (n = 9), bone disorders (n = 11), connective tissue diseases (n = 8), overgrowth syndromes (n = 3), and others (n = 8). Out of the 76 diseases, 61 (80%) are classified as chronic, with a remitting-relapsing course in 27 cases (35%) upon adequate treatment. Another 34 (45%) diseases were predominantly progressive and difficult to control. Corticosteroids are a therapeutic option in 49 (64%) syndromes. Mortality is variable and could not be determined precisely. Epidemiological studies and prevalence data were available for 33 syndromes and diseases. For an additional eight diseases, only incidence data were accessible. The summed prevalence of all RDs was 28.8/10,000. CONCLUSIONS RDs in rheumatology are frequently chronic, progressive, and present variable symptoms. Treatment options are often restricted to corticosteroids, presumably because of the scarcity of randomized controlled trials. The estimated combined prevalence is significant and almost double that of ankylosing spondylitis (18/10,000). Thus, healthcare systems should assign RDs similar importance as any other common disease in rheumatology.
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Affiliation(s)
- Judith Leyens
- Center for Rare Diseases Bonn (ZSEB), University Hospital, Bonn, Germany
- Department of Neonatology and Pediatric Care, Children's University Hospital, Bonn, Germany
| | - Tim Th A Bender
- Center for Rare Diseases Bonn (ZSEB), University Hospital, Bonn, Germany
- Institute of Human Genetics, University Hospital, Bonn, Germany
| | - Martin Mücke
- Center for Rare Diseases Bonn (ZSEB), University Hospital, Bonn, Germany
| | - Christiane Stieber
- Institute of General Practice and Family Medicine, University Hospital, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Dmitrij Kravchenko
- Center for Rare Diseases Bonn (ZSEB), University Hospital, Bonn, Germany
- Department of Radiology, University Hospital, Bonn, Germany
| | - Christian Dernbach
- Division of Medical Psychology and Department of Psychiatry, University Hospital, Bonn, Germany
| | - Matthias F Seidel
- Department of Rheumatology, Spitalzentrum-Centre hospitalier, Biel-Bienne, Switzerland.
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44
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Radonjic-Hoesli S, Brüggen MC, Feldmeyer L, Simon HU, Simon D. Eosinophils in skin diseases. Semin Immunopathol 2021; 43:393-409. [PMID: 34097126 PMCID: PMC8241748 DOI: 10.1007/s00281-021-00868-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/06/2021] [Indexed: 02/06/2023]
Abstract
Eosinophil infiltration is a common finding in a broad spectrum of skin diseases, despite the fact that the skin is devoid of eosinophils under physiologic conditions. Although cutaneous eosinophilia is reactive, cytokine-mediated in most cases, diseases with an intrinsic mutation-mediated clonal expansion of eosinophils can also manifest on the skin. As eosinophils are involved in host defense, regulate immune responses, generate pruritus, induce remodeling and fibrosis, and can cause tissue damage, they have the capacity to actively contribute to the pathogenesis of diseases. Recent research provided deeper insights in the mechanisms, e.g., bacterial and viral clearance, blister formation, recruitment of cytotoxic T cells, and generation of pruritus, by which eosinophils might come into action. This review aims at providing an overview on the clinical presentations of eosinophil-associated dermatoses and the current understanding of their pathogenic role in these diseases. Further, we discuss the effects of therapies targeting eosinophils.
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Affiliation(s)
- Susanne Radonjic-Hoesli
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marie-Charlotte Brüggen
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Department of Dermatology, Hochgebirgsklinik Davos, Davos, Switzerland
| | - Laurence Feldmeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hans-Uwe Simon
- Institute of Pharmacology, University of Bern, Bern, Switzerland
- Department of Clinical Immunology and Allergology, Sechenov University, Moscow, Russia
- Laboratory of Molecular Immunology, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Dagmar Simon
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Shamriz O, Hershko AY, Talmon A, Ribak Y, Elazary AS, Horev L, NaserEddin A, Neuman T, Shabat S, Zlotogorski A, Tal Y. The efficacy of off-label IL-5-modulating treatment in rare eosinophil-mediated diseases. Allergol Int 2021; 70:266-268. [PMID: 33779559 DOI: 10.1016/j.alit.2020.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/26/2020] [Accepted: 09/03/2020] [Indexed: 01/07/2023] Open
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Rosen J, Miteva M. SnapshotDx Quiz: April 2021. J Invest Dermatol 2021. [PMID: 33752813 DOI: 10.1016/j.jid.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jordan Rosen
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Mariya Miteva
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
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Aun JA, Knox RS, Roberts JE. The enigmatic fascia: eosinophilic fasciitis. J Osteopath Med 2021; 121:555-559. [PMID: 33783170 DOI: 10.1515/jom-2020-0284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 02/23/2021] [Indexed: 11/15/2022]
Abstract
This case report highlights the potentially underrecognized subtype of unilateral eosinophilic fasciitis (EF) in a 28 year old man. With fewer than 300 reported encounters to date, EF is a rare disease that eludes clinicians by presenting as a scleroderma like syndrome. As EF remains a clinical diagnosis, biopsy results may be nonspecific, and the disease can easily be misdiagnosed (or missed entirely) if a full thickness biopsy is not reviewed by a dermatopathologist. The authors also emphasize the importance of internationally accepted diagnostic criteria, of which at least two different sets exist.
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Affiliation(s)
- Jonathan A Aun
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Department of Cardiology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Rachel S Knox
- Department of Internal Medicine, Keesler Medical Center, Biloxi, MS, USA
| | - Jared E Roberts
- Department of Dermatology, Keesler Medical Center, Biloxi, MS, USA
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Chalopin T, Vallet N, Morel M, Maguet R, d'Alteroche L, de Pinieux G, Hérault O, Gyan E, Sutton L, Villate A. Eosinophilic fasciitis (Shulman syndrome), a rare entity and diagnostic challenge, as a manifestation of severe chronic graft-versus-host disease: a case report. J Med Case Rep 2021; 15:135. [PMID: 33722291 PMCID: PMC7958384 DOI: 10.1186/s13256-021-02735-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 02/15/2021] [Indexed: 11/25/2022] Open
Abstract
Background Shulman’s disease, or eosinophilic fasciitis (EF), is a rare autoimmune disease, characterized by sclerodermic skin lesions with progressive induration and thickening of the soft tissues. Chronic graft-versus-host-disease (GVHD) presenting as EF is a very rare manifestation of cutaneous GVHD. Case presentation We report an unusual case of EF in a 46-year-old Caucasian male patient who had received an allogenic hematopoietic stem cell transplantation in the context of relapsed/refractory multiple myeloma. The diagnosis was challenging, with the patient presenting hepatic dysfunction, normal eosinophils count, and incomplete clinical signs. Magnetic resonance imaging (MRI) and skin biopsy confirmed the diagnosis of EF. Early initiation of specific treatment with corticosteroids and prednisolone achieved complete response. Conclusion In practice, incomplete signs in this rare complication should lead to MRI as it is a major tool to guide decision-making based on the skin biopsy, allowing a rapid diagnosis and the initiation of treatment without delay.
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Affiliation(s)
- Thomas Chalopin
- Department of Hematology and Cell Therapy, University Hospital of Tours, 2 Boulevard Tonnellé, 37044, Tours Cedex 9, France
| | - Nicolas Vallet
- Department of Hematology and Cell Therapy, University Hospital of Tours, 2 Boulevard Tonnellé, 37044, Tours Cedex 9, France
| | - Marion Morel
- Department of Medical Imaging, University Hospital of Tours, Tours, France
| | - Raphael Maguet
- Department of Hematology and Cell Therapy, University Hospital of Tours, 2 Boulevard Tonnellé, 37044, Tours Cedex 9, France
| | - Louis d'Alteroche
- Department of Hepatology, University Hospital of Tours, Tours, France
| | | | - Olivier Hérault
- Department of Biological Hematology, University Hospital of Tours, Tours, France.,Groupe Innovation et Ciblage Cellulaire EA 7501, ERL 7001 LNOx, CNRS-University of Tours, Tours, France
| | - Emmanuel Gyan
- Department of Hematology and Cell Therapy, University Hospital of Tours, 2 Boulevard Tonnellé, 37044, Tours Cedex 9, France.,Groupe Innovation et Ciblage Cellulaire EA 7501, ERL 7001 LNOx, CNRS-University of Tours, Tours, France.,Clinical Investigation Center, University Hospital of Tours-INSERM U1415, Tours, France
| | - Laurent Sutton
- Department of Hematology and Cell Therapy, University Hospital of Tours, 2 Boulevard Tonnellé, 37044, Tours Cedex 9, France
| | - Alban Villate
- Department of Hematology and Cell Therapy, University Hospital of Tours, 2 Boulevard Tonnellé, 37044, Tours Cedex 9, France.
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Affiliation(s)
- Tuba Yuce Inel
- Department of Rheumatology, Dokuz Eylul University School of Medicine, Izmir, Turkey
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Eosinophilic fasciitis in a pregnant woman with corticosteroid dependence and good response to infliximab. Rheumatol Int 2021; 41:1531-1539. [PMID: 33484332 DOI: 10.1007/s00296-021-04787-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Abstract
Eosinophilic fasciitis (EF) is characterized by symmetrical thickening of subcutaneous muscular fascia, causing skin induration with wrinkles and prominent hair follicles: the classic peau d'orange. Eosinophilia is a characteristic-albeit not universal-finding. We present the case of a 43-year-old pregnant woman diagnosed with EF during pregnancy who had extensive cutaneous involvement and severe functional repercussions, including worsening of lung function and intrauterine growth restriction as a possible complication. Treatment with prednisone was initiated during gestation and it was necessary to increase the dose. After delivery, methotrexate treatment was initiated and the corticosteroid dose progressively decreased, with progressive worsening in the torso and abdomen and secondary dyspnea due to thoracic pressure. Treatment with infliximab was then initiated, with favorable progress, though residual ankle and tarsal joint stiffness and significant muscular atrophy in the limbs continued. The triggering factor of EF was not identified. In a systematic search of the medical literature, three cases of EF in pregnant woman without clear triggers were found. Interestingly, all three cases progressed favorably with steroid treatment. Apart from this case, there are only seven published cases of infliximab use in the literature, all with moderate or complete response. Infliximab could be an option for corticosteroid-dependent EF with no response to other options.
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