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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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2
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Ou Yang O, Crepaldi BE, Berger A. Eosinophilic Fasciitis - Beware of the Rare Form of Hand Contracture. J Hand Surg Asian Pac Vol 2020; 25:129-132. [PMID: 32000611 DOI: 10.1142/s2424835520720054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Eosinophilic fasciitis (EF) is a rare form of fibrosing disorder associated with peripheral eosinophilia with scleroderma-like skin induration and fasciitis in the extremities resulting in painful swelling, erythema and progressive contracture. We present a case report of EF and a literature review to raise awareness of this unusual condition and also highlight key features in its management.
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Affiliation(s)
- Owen Ou Yang
- Victorian Hand Surgery Associates, Hand Unit, St. Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Bruno E Crepaldi
- Victorian Hand Surgery Associates, Hand Unit, St. Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Anthony Berger
- Victorian Hand Surgery Associates, Hand Unit, St. Vincent's Hospital Melbourne, Fitzroy, Australia
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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: 104] [Impact Index Per Article: 17.3] [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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Fonseca MES, Quaresma MV, Luppino-Assad AP, da Silva HC, Andrade DCO, Sampaio-Barros PD. Eosinophilic fasciitis during pregnancy: case report and review of literature. Rheumatol Int 2017; 38:525-529. [PMID: 29247348 DOI: 10.1007/s00296-017-3908-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 12/06/2017] [Indexed: 11/25/2022]
Abstract
The authors describe the case of a 23-year-old woman who was referred to the rheumatologist due to symmetrical and progressive stiffness, induration, and swelling of arms and thighs at the 12th week of her first gestation. The characteristic clinical aspect of 'peau d'orange', associated to the histopathologic results of the deep biopsy of the skin confirmed the diagnosis of eosinophilic fasciitis. Treatment with oral prednisone, at an initial dose of 1 mg/kg/day, was effective and rapidly tapered to 10 mg/day till the birth of a healthy newborn. A literature review showed only one previous description of pregnancy and eosinophilic fasciitis.
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Affiliation(s)
- Maria Ester Simeira Fonseca
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Maria Victória Quaresma
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Ana Paula Luppino-Assad
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Henrique Carriço da Silva
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Danieli Castro O Andrade
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Percival D Sampaio-Barros
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil.
- Disciplina de Reumatologia, Universidade de São Paulo, Avenida Dr. Arnaldo 455, sala 3142, Cerqueira César, São Paulo, SP, CEP: 01246-903, Brazil.
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Silva L, Trevisan T, Torricelli A, Neto M, Shinjo S. FASCIÍTE EOSINOFÍLICA: RELATO DE CASO. REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2017.07.043] [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] Open
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Sharma A, Ray R, Sridhar J, Trehan A, Khandare M. A rare case of unilateral eosinophilic fasciitis associated with ipsilateral extragenital lichen sclerosus. Indian Dermatol Online J 2016; 7:386-389. [PMID: 27730034 PMCID: PMC5038099 DOI: 10.4103/2229-5178.190516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Eosinophilic fasciitis, also known as Shulman's syndrome, is a fibrosing scleroderma-like syndrome, which is a distinct entity. A 55-year-old man, presented with progressive skin darkening, thickening, and tightening over the left lower limb since 6 months. Dermatological examination revealed a hyperpigmented indurated area on the left thigh, extending to the anterior aspect of the left leg. A well-defined hypopigmented indurated plaque was present over the left iliac region. Histopathology and imaging studies confirmed the diagnosis of eosinophilic fasciitis and lichen sclerosus. The indurated lesion on the left lower limb responded dramatically well to oral corticosteroids. This is a rare case of unilateral eosinophilic fasciitis associated with ipsilateral extragenital lichen sclerosus.
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Affiliation(s)
- Aseem Sharma
- Department of Dermatology, Indian Naval Hospital Ship Asvini, Mumbai, Maharashtra, India
| | - Rahul Ray
- Department of Dermatology, Indian Naval Hospital Ship Asvini, Mumbai, Maharashtra, India
| | - Jandhyala Sridhar
- Department of Dermatology, Indian Naval Hospital Ship Asvini, Mumbai, Maharashtra, India
| | - Arti Trehan
- Department of Pathology, Indian Naval Hospital Ship Asvini, Mumbai, Maharashtra, India
| | - Manish Khandare
- Department of Dermatology, Indian Naval Hospital Ship Asvini, Mumbai, Maharashtra, India
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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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Alolabi B, Lesieur M, Smilovici B, Koo K, El Bahtimi R, Jenkinson RJ. Forearm compartment syndrome as a result of eosinophilic fasciitis: case report. J Hand Surg Am 2015; 40:707-10. [PMID: 25747740 DOI: 10.1016/j.jhsa.2015.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 01/08/2015] [Accepted: 01/08/2015] [Indexed: 02/02/2023]
Abstract
Eosinophilic fasciitis is an uncommon scleroderma-like connective tissue disease, usually characterized by symmetrical and painful swelling and induration of the skin and thickened fascia infiltrated with lymphocytes and eosinophils. A middle-aged woman with follicular lymphoma being treated with chemotherapy presented with acute onset atraumatic forearm swelling and severe pain. The history, physical examination, and pressure measurements were consistent with compartment syndrome. Intraoperative biopsy of the forearm fascia confirmed eosinophilic fasciitis.
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Affiliation(s)
- Bashar Alolabi
- Department of Surgery, Hamilton General Hospital, Hamilton, Ontario, Canada; Department of Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada; Department of Pathology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.
| | - Martin Lesieur
- Department of Surgery, Hamilton General Hospital, Hamilton, Ontario, Canada; Department of Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada; Department of Pathology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Brian Smilovici
- Department of Surgery, Hamilton General Hospital, Hamilton, Ontario, Canada; Department of Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada; Department of Pathology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Kevin Koo
- Department of Surgery, Hamilton General Hospital, Hamilton, Ontario, Canada; Department of Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada; Department of Pathology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Reem El Bahtimi
- Department of Surgery, Hamilton General Hospital, Hamilton, Ontario, Canada; Department of Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada; Department of Pathology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Richard J Jenkinson
- Department of Surgery, Hamilton General Hospital, Hamilton, Ontario, Canada; Department of Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada; Department of Pathology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
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Kirchgesner T, Dallaudière B, Omoumi P, Malghem J, Vande Berg B, Lecouvet F, Houssiau F, Galant C, Larbi A. Eosinophilic fasciitis: Typical abnormalities, variants and differential diagnosis of fasciae abnormalities using MR imaging. Diagn Interv Imaging 2015; 96:341-8. [DOI: 10.1016/j.diii.2014.06.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 06/11/2014] [Accepted: 06/23/2014] [Indexed: 01/14/2023]
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Pinal-Fernandez I, Selva-O' Callaghan A, Grau J. Diagnosis and classification of eosinophilic fasciitis. Autoimmun Rev 2014; 13:379-82. [DOI: 10.1016/j.autrev.2014.01.019] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2013] [Indexed: 10/25/2022]
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Lebeaux D, Sène D. Eosinophilic fasciitis (Shulman disease). Best Pract Res Clin Rheumatol 2012; 26:449-58. [DOI: 10.1016/j.berh.2012.08.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 08/06/2012] [Indexed: 10/27/2022]
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