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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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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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Soontrapa P, Shahar S, Eauchai L, Ernste FC, Liewluck T. Disease spectrum of myopathies with elevated aldolase and normal creatine kinase. Eur J Neurol 2024; 31:e16117. [PMID: 37922500 PMCID: PMC11235866 DOI: 10.1111/ene.16117] [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: 07/26/2023] [Revised: 09/29/2023] [Accepted: 10/11/2023] [Indexed: 11/05/2023]
Abstract
BACKGROUND AND PURPOSE Elevation of serum creatine kinase (CK) or hyperCKemia is considered a biological marker of myopathies. However, selective elevation of serum aldolase with normal CK has been reported in a few myopathies, including dermatomyositis, immune-mediated myopathy with perimysial pathology and fasciitis with associated myopathy. The aim was to investigate the disease spectrum of myopathies with isolated aldolase elevation. METHODS Medical records were reviewed to identify patients >18 years old seen between December 1994 and June 2020 who had pathologically proven myopathies with elevated aldolase and normal CK level. Patients with alternative causes of aldolase elevation were excluded. RESULTS Thirty-four patients with various types of myopathies were identified. Myopathies were treatable in 27 patients. The three most common etiologies were dermatomyositis (n = 8), overlap myositis (n = 4) and nonspecific myopathy (n = 4). Perimysial pathology comprising inflammation, fragmentation, vasculitis, calcified perimysial vessels or extracellular amyloid deposition was found in 17/34 patients (50%). Eight dermatomyositis patients with selective elevated aldolase were compared to 24 sex- and age-matched patients with dermatomyositis and hyperCKemia. Dermatomyositis patients with normal CK significantly (p < 0.05) had less frequent cutaneous involvement (50.0% vs. 100.0%) and fibrillation potentials (50.0% vs. 90.5%) but higher median erythrocyte sedimentation rate (33.5 vs. 13.5 mm/h) and more common perifascicular mitochondrial pathology (37.5% vs. 4.2%). CONCLUSION Isolated aldolase elevation can be found in a greater variety of myopathies than initially thought and most were treatable. Dermatomyositis is the most common myopathy with selective elevation of aldolase in our cohort, which features some unique characteristics compared to dermatomyositis with hyperCKemia.
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Affiliation(s)
- Pannathat Soontrapa
- Department of Neurology, Division of Neuromuscular MedicineMayo ClinicRochesterMinnesotaUSA
- Department of Medicine, Division of Neurology, Siriraj HospitalMahidol UniversityBangkokThailand
| | - Shelly Shahar
- Department of Neurology, Division of Neuromuscular MedicineMayo ClinicRochesterMinnesotaUSA
- Department of NeurologyRambam Health Care CampusHaifaIsrael
- Bruce Rappaport Faculty of MedicineTechnion‐Israel Institute of TechnologyHaifaIsrael
| | - Lattawat Eauchai
- Department of Neurology, Division of Neuromuscular MedicineMayo ClinicRochesterMinnesotaUSA
- Department of Anatomy, Siriraj HospitalMahidol UniversityBangkokThailand
| | - Floranne C. Ernste
- Department of Medicine, Division of RheumatologyMayo ClinicRochesterMinnesotaUSA
| | - Teerin Liewluck
- Department of Neurology, Division of Neuromuscular MedicineMayo ClinicRochesterMinnesotaUSA
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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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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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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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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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Asada S, Douhara A, Murata K, Yanase K, Tsutsumi M, Yoshiji H. A Histologically Proven Case of Autoimmune Hepatitis with Eosinophilic Fasciitis. Intern Med 2019; 58:667-673. [PMID: 30333401 PMCID: PMC6443560 DOI: 10.2169/internalmedicine.1299-18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Both autoimmune hepatitis (AIH) and eosinophilic fasciitis (EF) are known to be complicated by other autoimmune diseases. However, AIH complicated by EF has never been reported. We experienced a 58-year-old man with AIH complicated by EF. He was admitted to our hospital with acute hepatic injury and edema of the legs in April 201X. The etiologies of these symptoms were histologically proven as AIH and EF. The administration of prednisolone (PSL) drastically improved his liver injury and edema of the legs. When we make a diagnosis of AIH, we should carefully evaluate the physical findings, including the appearance of the legs, in order to detect other coexisting autoimmune diseases.
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Affiliation(s)
- Shohei Asada
- Department of Internal Medicine, Saiseikai Chuwa Hospital, Japan
| | - Akitoshi Douhara
- Department of Internal Medicine, Saiseikai Chuwa Hospital, Japan
| | - Koji Murata
- Department of Internal Medicine, Saiseikai Chuwa Hospital, Japan
| | - Koji Yanase
- Department of Internal Medicine, Saiseikai Chuwa Hospital, Japan
| | | | - Hitoshi Yoshiji
- Third department of Internal Medicine, Nara Medical University, Japan
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Jinnin M, Yamamoto T, Asano Y, Ishikawa O, Sato S, Takehara K, Hasegawa M, Fujimoto M, Ihn H. Diagnostic criteria, severity classification and guidelines of eosinophilic fasciitis. J Dermatol 2018; 45:881-890. [PMID: 29235676 DOI: 10.1111/1346-8138.14160] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 11/06/2017] [Indexed: 11/28/2022]
Abstract
We established diagnostic criteria and severity classification of eosinophilic fasciitis because there is no established diagnostic criteria or widely accepted severity classification of the disease. Also, there has been no clinical guideline for eosinophilic fasciitis, so we established its clinical guideline ahead of all over the world. In particular, the clinical guideline was established by clinical questions based on evidence-based medicine according to the New Minds Clinical Practice Guideline Creation Manual (version 1.0). We aimed to make the guideline easy to use and reliable based on the newest evidence, and to present guidance as specific as possible for various clinical problems in treatment of eosinophilic fasciitis.
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Affiliation(s)
- Masatoshi Jinnin
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Toshiyuki Yamamoto
- Department of Dermatology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yoshihide Asano
- Department of Dermatology, The University of Tokyo Hospital, Tokyo, Japan
| | - Osamu Ishikawa
- Department of Dermatology, Graduate School of Medicine, Gunma University, Gunma, Japan
| | - Shinichi Sato
- Department of Dermatology, The University of Tokyo Hospital, Tokyo, Japan
| | - Kazuhiko Takehara
- Department of Molecular Pathology of Skin, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Minoru Hasegawa
- Department of Dermatology Division, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hironobu Ihn
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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Ferreli C, Gasparini G, Parodi A, Cozzani E, Rongioletti F, Atzori L. Cutaneous Manifestations of Scleroderma and Scleroderma-Like Disorders: a Comprehensive Review. Clin Rev Allergy Immunol 2018; 53:306-336. [PMID: 28712039 DOI: 10.1007/s12016-017-8625-4] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Scleroderma refers to an autoimmune connective tissue fibrosing disease, including three different subsets: localized scleroderma, limited cutaneous systemic sclerosis, and diffuse cutaneous systemic sclerosis with divergent patterns of organ involvement, autoantibody profiles, management, and prognostic implications. Although systemic sclerosis is considered the disease prototype that causes cutaneous sclerosis, there are many other conditions that can mimic and be confused with SSc. They can be classified into immune-mediated/inflammatory, immune-mediated/inflammatory with abnormal deposit (mucinoses), genetic, drug-induced and toxic, metabolic, panniculitis/vascular, and (para)neoplastic disorders according to clinico-pathological and pathogenetic correlations. This article reviews the clinical presentation with emphasis on cutaneous disease, etiopathogenesis, diagnosis, and treatment options available for the different forms of scleroderma firstly and for scleroderma-like disorders, including scleromyxedema, scleredema, nephrogenic systemic fibrosis, eosinophilic fasciitis, chronic graft-versus-host disease, porphyria cutanea tarda, diabetic stiff-hand syndrome (diabetic cheiroartropathy), and other minor forms. This latter group of conditions, termed also scleroderma mimics, sclerodermiform diseases, or pseudosclerodermas, shares the common thread of skin thickening but presents with distinct cutaneous manifestations, skin histology, and systemic implications or disease associations, differentiating each entity from the others and from scleroderma. The lack of Raynaud's phenomenon, capillaroscopic abnormalities, or scleroderma-specific autoantibodies is also important diagnostic clues. As cutaneous involvement is the earliest, most frequent and characteristic manifestation of scleroderma and sclerodermoid disorders, dermatologists are often the first-line doctors who must be able to promptly recognize skin symptoms to provide the affected patient a correct diagnosis and appropriate management.
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Affiliation(s)
- Caterina Ferreli
- Section of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
| | - Giulia Gasparini
- Section of Dermatology, Department of Health Sciences, DISSAL, IRCSS-AOU S. Martino-IST, University of Genoa, Genoa, Italy
| | - Aurora Parodi
- Section of Dermatology, Department of Health Sciences, DISSAL, IRCSS-AOU S. Martino-IST, University of Genoa, Genoa, Italy
| | - Emanuele Cozzani
- Section of Dermatology, Department of Health Sciences, DISSAL, IRCSS-AOU S. Martino-IST, University of Genoa, Genoa, Italy
| | - Franco Rongioletti
- Section of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Laura Atzori
- Section of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Ernest V, Sautereau N, Masson E, Chemouni D, Garcia M, Bertolino J, Rossi P, Granel B. [Eosinophilia heralding the diagnosis of eosinophilic fasciitis (Shulman's disease)]. Rev Med Interne 2017; 38:840-843. [PMID: 28867532 DOI: 10.1016/j.revmed.2017.07.010] [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: 02/12/2017] [Revised: 07/07/2017] [Accepted: 07/25/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Eosinophilic fasciitis or Shulman's disease is characterized, in its typical form, by palpable thickening of the skin and soft tissues, blood hypereosinophilia and fascia lesions. We hereby report a case of eosinophilic fasciitis in which hypereosinophilia preceded for several months the clinical signs of fasciitis. CASE REPORT A 64-year-old woman, with a history of Little's syndrome with motor disability, was admitted in internal medicine for eosinophilia. For almost three months, no origin to the eosinophilia was found. The secondary onset of an edema and pain located on four limbs led to the diagnosis of eosinophilic fasciitis. Muscle magnetic resonance imaging was supportive and the muscle histological analysis confirmed the diagnosis of eosinophilic fasciitis. Treatment with steroids induced a rapid normalization of the eosinophilia and edema. CONCLUSION In this case report, eosinophilia was preceding the clinical cutaneous signs that led to the diagnosis of eosinophilic fasciitis. It is likely to believe that myalgias, frequently found in the onset of eosinophilic fasciitis, may have been hidden by the history of infantile encephalopathy. The diagnosis of eosinophilic fasciitis must be kept in mind of physicians in the investigation of an eosinophilia, even though cutaneous signs are lacking.
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Affiliation(s)
- V Ernest
- Service de médecine interne, hôpital Nord, Aix-Marseille université, Assistance publique-Hôpitaux de Marseille (AP-HM), chemin des Bourrely, 13915 Marseille cedex 15, France
| | - N Sautereau
- Service de médecine interne, hôpital Nord, Aix-Marseille université, Assistance publique-Hôpitaux de Marseille (AP-HM), chemin des Bourrely, 13915 Marseille cedex 15, France
| | - E Masson
- Service de médecine interne, hôpital Nord, Aix-Marseille université, Assistance publique-Hôpitaux de Marseille (AP-HM), chemin des Bourrely, 13915 Marseille cedex 15, France
| | - D Chemouni
- Service d'imagerie médicale, hôpital Nord, Aix-Marseille université, Assistance publique-Hôpitaux de Marseille (AP-HM), chemin des Bourrely, 13915 Marseille cedex 15, France
| | - M Garcia
- Service de médecine interne, hôpital Nord, Aix-Marseille université, Assistance publique-Hôpitaux de Marseille (AP-HM), chemin des Bourrely, 13915 Marseille cedex 15, France
| | - J Bertolino
- Service de médecine interne, hôpital Nord, Aix-Marseille université, Assistance publique-Hôpitaux de Marseille (AP-HM), chemin des Bourrely, 13915 Marseille cedex 15, France
| | - P Rossi
- Service de médecine interne, hôpital Nord, Aix-Marseille université, Assistance publique-Hôpitaux de Marseille (AP-HM), chemin des Bourrely, 13915 Marseille cedex 15, France
| | - B Granel
- Service de médecine interne, hôpital Nord, Aix-Marseille université, Assistance publique-Hôpitaux de Marseille (AP-HM), chemin des Bourrely, 13915 Marseille cedex 15, France.
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Takahashi H, Tsuboi H, Abe S, Yokosawa M, Hagiwara S, Asashima H, Hirota T, Umeda N, Kondo Y, Matsumoto I, Sumida T. Magnetic resonance imaging can reveal fascial vasculitis in a patient with microscopic polyangiitis. Scand J Rheumatol 2015; 44:511-3. [PMID: 26399877 DOI: 10.3109/03009742.2015.1085084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- H Takahashi
- a Department of Internal Medicine, Faculty of Medicine , University of Tsukuba , Ibaraki , Japan
| | - H Tsuboi
- a Department of Internal Medicine, Faculty of Medicine , University of Tsukuba , Ibaraki , Japan
| | - S Abe
- a Department of Internal Medicine, Faculty of Medicine , University of Tsukuba , Ibaraki , Japan
| | - M Yokosawa
- a Department of Internal Medicine, Faculty of Medicine , University of Tsukuba , Ibaraki , Japan
| | - S Hagiwara
- a Department of Internal Medicine, Faculty of Medicine , University of Tsukuba , Ibaraki , Japan
| | - H Asashima
- a Department of Internal Medicine, Faculty of Medicine , University of Tsukuba , Ibaraki , Japan
| | - T Hirota
- a Department of Internal Medicine, Faculty of Medicine , University of Tsukuba , Ibaraki , Japan
| | - N Umeda
- a Department of Internal Medicine, Faculty of Medicine , University of Tsukuba , Ibaraki , Japan
| | - Y Kondo
- a Department of Internal Medicine, Faculty of Medicine , University of Tsukuba , Ibaraki , Japan
| | - I Matsumoto
- a Department of Internal Medicine, Faculty of Medicine , University of Tsukuba , Ibaraki , Japan
| | - T Sumida
- a Department of Internal Medicine, Faculty of Medicine , University of Tsukuba , Ibaraki , Japan
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14
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Sène D. [Eosinophilic fasciitis (Shulman's disease): Diagnostic and therapeutic review]. Rev Med Interne 2015; 36:738-45. [PMID: 26385125 DOI: 10.1016/j.revmed.2015.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 08/01/2015] [Accepted: 08/03/2015] [Indexed: 11/16/2022]
Abstract
Eosinophilic fasciitis (EF) is a rare connective tissue disease characterized by symmetrical and painful swelling with a progressive induration and thickening of the skin and soft tissues. The diagnosis of EF is often based on the association of characteristic skin or subcutaneous abnormalities and a thickened fascia with an inflammatory infiltration, mostly composed of lymphocytes and eosinophils. A peripheral eosinophilia is frequently present (60-90%) but is not mandatory for the EF diagnosis. At the onset, the morphological diagnosis might be helped by a muscle magnetic resonance imaging, which typically may evidence an increased signal intensity within the fascia and marked fascia enhancement after gadolinium administration at the acute phase of the disease. Differential diagnoses include eosinophilia-myalgia syndrome after L-tryprophane ingestion, hypereosinophilic syndromes (HES), systemic sclerosis, eosinophilic granulomatosis with polyangeitis, and peripheral T cell lymphomas with cutaneous involvement. There is no consensual therapeutic strategy. However, oral corticosteroids, with or without methylprednisolone pluses, remain the mainstay treatment with a significant improvement for the majority of patients. It might be associated to an immunosuppressive drug, mainly methotrexate, in patients with morphea-like lesions or an unsatisfactory response to corticosteroids alone.
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Affiliation(s)
- D Sène
- Université Paris-Cité Sorbonne Paris-Diderot, 75013 Paris, France; Service de médecine interne, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France.
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