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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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[Paraneoplastic syndromes in rheumatology]. Z Rheumatol 2023; 82:212-219. [PMID: 36690750 DOI: 10.1007/s00393-022-01314-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 01/24/2023]
Abstract
Paraneoplastic syndromes in rheumatology are a group of canonical rare rheumatic diseases with musculoskeletal involvement that occur in close temporal and causal association with malignancies. Knowledge of these possibly enables a prognostically relevant early diagnosis of the underlying malignant disease. In the era of immune checkpoint inhibitor treatment, there are first indications of an increase in the incidence and severity of paraneoplastic syndromes, so that they are becoming of increasing importance for the practicing rheumatologist. These nine syndromes, paraneoplastic arthritis, palmar fasciitis and polyarthritis, remitting seronegative symmetrical synovitis with pitting edema, pancreatic panniculitis with polyarthritis, paraneoplastic vasculitis, cancer-associated myositis, hypertrophic osteoarthropathy (Marie-Bamberger), eosinophilic fasciitis and tumor-induced osteomalacia, usually occur with characteristic courses and sometimes pathognomonic clinical manifestations, which are presented in this article accompanied by the rational use of a diagnostic algorithm for tumor detection. With frequently disappointing therapeutic response to glucocorticoids, nonsteroidal antirheumatic drugs and immunosuppressants, treatment of the underlying malignant disease represents the crucial step in the treatment of paraneoplastic syndromes.
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Mazilu D, Boltașiu (Tătaru) LA, Mardale DA, Bijă MS, Ismail S, Zanfir V, Negoi F, Balanescu AR. Eosinophilic Fasciitis: Current and Remaining Challenges. Int J Mol Sci 2023; 24:ijms24031982. [PMID: 36768300 PMCID: PMC9916848 DOI: 10.3390/ijms24031982] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/09/2023] [Accepted: 01/14/2023] [Indexed: 01/20/2023] Open
Abstract
Eosinophilic fasciitis (EF), defined as diffuse fasciitis with eosinophilia by Shulman in 1974, is a disease with unknown etiology and whose pathogenesis is still being researched. The diagnosis is based on the clinical aspects (skin induration with an "orange peel" appearance), the lab results (eosinophilia, increased inflammatory markers), the skin biopsy with the pathognomonic histopathological result, as well as the typical MRI changes. The treatment includes glucocorticoids and immunosuppressive drugs. Due to severe refractory cases, the treatment remains a challenge. EF is still a disease with potential for further research.
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Affiliation(s)
- Diana Mazilu
- “Sfanta Maria” Clinical Hospital, Ion Mihalache blvd, 37-39, 011172 Bucharest, Romania
- “Carol Davila” University of Medicine, Dionisie Lupu Street, nr 37, 020021 Bucharest, Romania
- Correspondence: (D.M.); (L.A.B.)
| | - Laura Alina Boltașiu (Tătaru)
- “Sfanta Maria” Clinical Hospital, Ion Mihalache blvd, 37-39, 011172 Bucharest, Romania
- Correspondence: (D.M.); (L.A.B.)
| | - Denise-Ani Mardale
- “Sfanta Maria” Clinical Hospital, Ion Mihalache blvd, 37-39, 011172 Bucharest, Romania
- “Carol Davila” University of Medicine, Dionisie Lupu Street, nr 37, 020021 Bucharest, Romania
| | - Maria Silviana Bijă
- “Sfanta Maria” Clinical Hospital, Ion Mihalache blvd, 37-39, 011172 Bucharest, Romania
| | - Sermina Ismail
- “Sfanta Maria” Clinical Hospital, Ion Mihalache blvd, 37-39, 011172 Bucharest, Romania
| | - Violeta Zanfir
- “Sfanta Maria” Clinical Hospital, Ion Mihalache blvd, 37-39, 011172 Bucharest, Romania
| | - Florentina Negoi
- “Sfanta Maria” Clinical Hospital, Ion Mihalache blvd, 37-39, 011172 Bucharest, Romania
| | - Andra Rodica Balanescu
- “Sfanta Maria” Clinical Hospital, Ion Mihalache blvd, 37-39, 011172 Bucharest, Romania
- “Carol Davila” University of Medicine, Dionisie Lupu Street, nr 37, 020021 Bucharest, Romania
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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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5
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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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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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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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Mastorino L, Avallone G, Dapavo P, Merli M, Agostini A, Grandinetti D, Fierro MT, Quaglino P, Ribero S. Tocilizumab and its usage for skin diseases. Ital J Dermatol Venerol 2020; 157:13-22. [PMID: 33314888 DOI: 10.23736/s2784-8671.20.06772-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The monoclonal anti-IL6 receptor antibody called Tocilizumab is widely used by rheumatologists for joint diseases. Its application in dermatology has mainly concerned scleroderma and Systemic Sclerosis in the last years. The most varied skin diseases treated with tocilizumab, such as psoriasis, psoriatic arthritis, Behcet's Syndrome, Lupus, and the already mentioned scleroderma up to multi-organ syndromes with skin involvement will be discussed. At the same time, there have been several side reactions to the drug involving the skin forcing careful skin monitoring during treatment. Despite the evidence currently available in the appropriate literature, there is no formal recommendation for any of these diseases to use Tocilizumab for therapeutic purposes. The aim of this review was to collect all the main evidence on the use and involvement of the drug in dermatological practice in order to stimulate further research or hypothesize on possible therapeutic options.
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Affiliation(s)
- Luca Mastorino
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Gianluca Avallone
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Paolo Dapavo
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Martina Merli
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Andrea Agostini
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Damiano Grandinetti
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Maria T Fierro
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Pietro Quaglino
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Simone Ribero
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy -
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