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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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2
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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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3
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Kim SH. Roles of Tissue Inhibitor of Metalloproteinase-1 in Severe Asthma. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2023; 15:416-418. [PMID: 37469240 DOI: 10.4168/aair.2023.15.4.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/21/2023]
Affiliation(s)
- Sang-Heon Kim
- Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea.
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4
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Cut loose TIMP-1: an emerging cytokine in inflammation. Trends Cell Biol 2022; 33:413-426. [PMID: 36163148 DOI: 10.1016/j.tcb.2022.08.005] [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: 07/06/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 11/21/2022]
Abstract
Appreciation of the entire biological impact of an individual protein can be hampered by its original naming based on one function only. Tissue inhibitor of metalloproteinases-1 (TIMP-1), mostly known for its eponymous function to inhibit metalloproteinases, exhibits only a fraction of its cellular effects via this feature. Recently, TIMP-1 emerged as a potent cytokine acting via various cell-surface receptors, explaining a so-far under-appreciated role of TIMP-1-mediated signaling on immune cells. This, at least partly, resolved why elevated blood levels of TIMP-1 correlate with progression of numerous inflammatory diseases. Here, we emphasize the necessity of unbiased name-independent recognition of structure-function relationships to properly appreciate the biological potential of TIMP-1 and other cytokines in complex physiological processes such as inflammation.
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5
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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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6
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Eosinophilic Fasciitis Unmasking a Lung Cancer. Am J Med 2022; 135:187-190. [PMID: 34560034 DOI: 10.1016/j.amjmed.2021.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/02/2021] [Accepted: 08/16/2021] [Indexed: 11/23/2022]
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7
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Foti R, De Pasquale R, Dal Bosco Y, Visalli E, Amato G, Gangemi P, Foti R, Ramondetta A. Clinical and Histopathological Features of Scleroderma-like Disorders: An Update. Medicina (B Aires) 2021; 57:medicina57111275. [PMID: 34833493 PMCID: PMC8625286 DOI: 10.3390/medicina57111275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/10/2021] [Accepted: 11/18/2021] [Indexed: 11/25/2022] Open
Abstract
Scleroderma-like disorders include a set of entities involving cutis, subcutis and, sometimes, even muscular tissue, caused by several pathogenetic mechanisms responsible for different clinical–pathological pictures. The absence of antinuclear antibodies (ANA), Raynaud’s phenomenon and capillaroscopic anomalies constitutes an important element of differential diagnosis with systemic sclerosis. When scleroderma can be excluded, on the basis of the main body sites, clinical evolution, any associated pathological conditions and specific histological features, it is possible to make a correct diagnosis.
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Affiliation(s)
- Rosario Foti
- Division of Reumathology, A.O.U. “Policlinico-San Marco”, 95123 Catania, Italy; (R.F.); (Y.D.B.); (E.V.); (G.A.)
| | - Rocco De Pasquale
- U.O. Dermatologia, Ospedale San Marco, 95123 Catania, Italy; (R.D.P.); (R.F.)
| | - Ylenia Dal Bosco
- Division of Reumathology, A.O.U. “Policlinico-San Marco”, 95123 Catania, Italy; (R.F.); (Y.D.B.); (E.V.); (G.A.)
| | - Elisa Visalli
- Division of Reumathology, A.O.U. “Policlinico-San Marco”, 95123 Catania, Italy; (R.F.); (Y.D.B.); (E.V.); (G.A.)
| | - Giorgio Amato
- Division of Reumathology, A.O.U. “Policlinico-San Marco”, 95123 Catania, Italy; (R.F.); (Y.D.B.); (E.V.); (G.A.)
| | - Pietro Gangemi
- U.O. Anatomia Patologica, Ospedale San Marco, 95123 Catania, Italy;
| | - Riccardo Foti
- U.O. Dermatologia, Ospedale San Marco, 95123 Catania, Italy; (R.D.P.); (R.F.)
| | - Alice Ramondetta
- U.O. Dermatologia, Ospedale San Marco, 95123 Catania, Italy; (R.D.P.); (R.F.)
- Correspondence: ; Tel.: +39-095-479-4298
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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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9
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Narula NG, Abril A, Calamia KT, Berianu F. Musculoskeletal ultrasound as a diagnostic tool for eosinophilic fasciitis and correlation with magnetic resonance imaging findings. Int J Rheum Dis 2021; 24:721-723. [PMID: 33890386 DOI: 10.1111/1756-185x.14099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/02/2021] [Accepted: 03/06/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Neha G Narula
- Division of Rheumatology, Mayo Clinic, Jacksonville, FL, USA
| | - Andy Abril
- Division of Rheumatology, Mayo Clinic, Jacksonville, FL, USA
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10
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Pabón-Cartagena G, López A, Watts E, Alonso N. Eosinophilic fasciitis in association with nivolumab: The importance of eosinophilia. JAAD Case Rep 2020; 6:1303-1306. [PMID: 33294570 PMCID: PMC7700974 DOI: 10.1016/j.jdcr.2020.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
| | - Andrea López
- University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Erika Watts
- Department of Dermatology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
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11
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Yamamoto T, Ito T, Asano Y, Sato S, Motegi SI, Ishikawa O, Matsushita T, Takehara K, Makino T, Okiyama N, Fujimoto M, Jinnin M, Ihn H. Characteristics of Japanese patients with eosinophilic fasciitis: A brief multicenter study. J Dermatol 2020; 47:1391-1394. [PMID: 32860239 DOI: 10.1111/1346-8138.15561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 07/14/2020] [Indexed: 12/11/2022]
Abstract
Eosinophilic fasciitis is a relatively rare cutaneous fibrotic condition affecting the deep fascia of the extremities, with or without peripheral blood eosinophilia. To examine the characteristics of Japanese patients with eosinophilic fasciitis, we conducted a brief, multicenter, retrospective survey at seven university hospitals. In total, 31 patients were identified as having eosinophilic fasciitis, among whom 30 patients fulfilled the Japanese diagnostic criteria. The male : female ratio was 2.3:1, and the mean age was 47.7 years. Three of the patients were under 20 years old. The possible triggering factors included muscle training, sports, walking or sitting for a long time, physical work, insect bite and drug. Co-occurrence of morphea was observed in nine cases (29%), and malignancies were associated in three (two hematological malignancies and one internal malignancy). Immunological abnormalities in the serum showed positive antinuclear antibody, positive rheumatoid factor, increased aldolase levels and increased immunoglobulin G levels. The patients were treated with either monotherapy or combination therapy by oral prednisolone (20-80 mg/day), methotrexate (6-10 mg/week), cyclosporin (100-150 mg/day), mizoribine, infliximab and phototherapy. Methylprednisolone pulse therapy was performed in six cases. By contrast, spontaneous improvement due to resting only was observed in two cases, and skin hardening was improved by withdrawal of the anticancer drug in one case. This study suggests several characteristics of Japanese patients with eosinophilic fasciitis, namely male predominance, rare pediatric occurrence, immunological abnormalities and coexistence with morphea. Systemic prednisolone is the first-line therapy, but pulse therapy is occasionally required for severe cases. The triggering events of physical stress are not so frequent as have previously been reported, and various factors or even unknown factors may be associated with the induction of eosinophilic fasciitis.
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Affiliation(s)
- Toshiyuki Yamamoto
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - Takashi Ito
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - Yoshihide Asano
- Department of Dermatology, University of Tokyo, Tokyo, Japan
| | - Shinichi Sato
- Department of Dermatology, University of Tokyo, Tokyo, Japan
| | | | - Osamu Ishikawa
- Department of Dermatology, Gunma University, Maebashi, Japan
| | | | | | | | - Naoko Okiyama
- Department of Dermatology, Tsukuba University, Tsukuba, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Tsukuba University, Tsukuba, Japan.,Department of Dermatology, Osaka University, Osaka, Japan
| | - Masatoshi Jinnin
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Hironobu Ihn
- Department of Dermatology, Kumamoto University, Kumamoto, Japan
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12
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Varjú C, Kumánovics G, Czirják L, Matucci-Cerinic M, Minier T. Sclerodermalike syndromes: Great imitators. Clin Dermatol 2019; 38:235-249. [PMID: 32513403 DOI: 10.1016/j.clindermatol.2019.10.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Sclerodermalike syndromes (SLSs) comprise diseases with mucin deposition (eg, scleromyxedema, scleredema), with eosinophilia (eg, eosinophilic fasciitis), metabolic or biochemical abnormalities (eg, nephrogenic systemic fibrosis), or endocrine disorders (eg, POEMS syndrome, or polyneuropathy, organomegaly, endocrinopathy, monoclonal lymphoproliferative disorder, and hypothyroidism). Chronic graft-versus-host disease may also show sclerodermalike skin changes. Inherited progeria syndromes with early aging (eg, Werner syndrome) and a heterogeneous group of hereditary disorders with either skin thickening (eg, stiff skin syndrome) or atrophy and tightening (eg, acrogeria) can also imitate classic systemic sclerosis (SSc). In addition, SLSs can be provoked by several drugs, chemicals, or even physical injury (eg, trauma, vibration stress, radiation). In SLSs, the distribution of skin involvement seems to be atypical compared with SSc. The acral skin involvement is usually missing, and lack of Raynaud phenomenon, scleroderma-specific antinuclear antibodies, the absence of scleroderma capillary pattern, and internal organ manifestations indicate the presence of an SLS. Skin involvement is sometimes nodular, and the underlying tissues can also be affected. For the differential diagnosis, a skin biopsy of the deeper layers including fascia and muscle is required. Histology does not always allow differentiation between SSc and SLSs; therefore, the diagnosis is often based on the distribution, quality of cutaneous involvement, and other accompanying clinical features.
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Affiliation(s)
- Cecília Varjú
- Department of Rheumatology and Immunology, University of Pécs Clinical Center, Pecs, Hungary
| | - Gábor Kumánovics
- Department of Rheumatology and Immunology, University of Pécs Clinical Center, Pecs, Hungary
| | - László Czirják
- Department of Rheumatology and Immunology, University of Pécs Clinical Center, Pecs, Hungary
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, Florence, Italy
| | - Tünde Minier
- Department of Rheumatology and Immunology, University of Pécs Clinical Center, Pecs, Hungary.
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Abstract
Eosinophilic fasciitis is a disease originally proposed as "diffuse fasciitis with eosinophilia" by Shulman in 1974. The patients with this disease often have history of strenuous exercise or labor a few days to 1-2 weeks before the onset. The chief symptoms are symmetrical, full-circumference swelling and plate-like hardness of the distal limbs. This is accompanied by redness and pain in the early stages, with many cases exhibiting systemic symptoms such as fever or generalized fatigue. The lesions have been observed extending to the proximal limbs, though never on the face or fingers. En bloc biopsies from the skin to the fascia show marked fascial thickening and inflammatory cell infiltration by the lymphocytes and plasma cells. Eosinophilic infiltration is useful for the diagnosis but is only seen in the early stages of the disease. Recently, "Diagnostic criteria, severity classification, and clinical guidelines for eosinophilic fasciitis" were published. This review article discusses about eosinophilic faciitis in detail, from its pathophysiology to the treatment.
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14
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Wollina U, Hansel G, Schönlebe J, Heinig B, Temelkova I, Tchernev G, Vojvocic A, Lotti T. Eosinophilic Fasciitis - Report of Three Cases and Review of the Literature. Open Access Maced J Med Sci 2019; 7:2964-2968. [PMID: 31850100 PMCID: PMC6910797 DOI: 10.3889/oamjms.2019.296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/03/2019] [Accepted: 05/04/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND: Eosinophilic fasciitis is a rare fibrosing disorder of muscle fascia with rapid onset of erythema, induration, oedema and tenderness affecting extremities bilaterally. CASE REPORT: We report three cases of eosinophilic fasciitis in 3 females aged 64, 65 and 73 years, in two of them in association with morphea. They fulfilled the proposed diagnostic criteria. Associated malignancies could be excluded in all of them. They were treated by systemic corticosteroids. In the two females with associated morphea higher prednisolone dosages and a combination with methotrexate was necessary. CONCLUSIONS: Eosinophilic fasciitis is a differential diagnosis of systemic scleroderma. Response to treatment is often delayed. Systemic corticosteroids are the first line therapy. Patients with associated morphea need combined drug therapy, in our patients with methotrexate. There is no close correlation between laboratory signs of inflammation and clinical response to treatment.
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Affiliation(s)
- Uwe Wollina
- Städtisches Klinikum Dresden, Department of Dermatology and Allergology, Dresden, Germany
| | - Gesina Hansel
- Städtisches Klinikum Dresden, Department of Dermatology and Allergology, Dresden, Germany
| | - Jacqueline Schönlebe
- Institute of Pathology "Georg Schmorl", Städtisches Klinikum Dresden, Academic Teaching Hospital, Dresden, Germany
| | - Birgit Heinig
- Center of Physical and Rehabilitative Medicine, Städtisches Klinikum Dresden, Academic Teaching Hospital, Dresden, Germany
| | - Ivanka Temelkova
- Onkoderma - Clinic for Dermatology, Venereology and Dermatologic Surgery, General Skobelev 26, 1606, Sofia, Bulgaria
| | - Georgi Tchernev
- Onkoderma - Clinic for Dermatology, Venereology and Dermatologic Surgery, General Skobelev 26, 1606, Sofia, Bulgaria
| | - Aleksandra Vojvocic
- Department of Dermatology and Venereology, Military Medical Academy of Belgrade, Belgrade, Serbia
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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: 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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Onajin O, Wieland CN, Peters MS, Lohse CM, Lehman JS. Clinicopathologic and immunophenotypic features of eosinophilic fasciitis and morphea profunda: A comparative study of 27 cases. J Am Acad Dermatol 2018; 78:121-128. [DOI: 10.1016/j.jaad.2017.06.148] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 06/14/2017] [Accepted: 06/22/2017] [Indexed: 11/16/2022]
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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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Abstract
Peripheral and tissue eosinophilia can be a prominent feature of several unique rheumatologic and vascular diseases. These diseases span a wide range of clinical features, histologic findings, therapeutic approaches, and outcomes. Despite the rare nature of these entities--which makes large-scale studies challenging--knowledge has continued to grow regarding their epidemiology, pathophysiology, and management. This review compares and contrasts 5 rheumatologic and vascular conditions in which eosinophilia can be seen: eosinophilic granulomatosis with polyangiitis (Churg-Strauss), immunoglobulin G4-related disease, diffuse fasciitis with eosinophilia, eosinophilia-myalgia syndrome, and eosinophilic myositis.
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Affiliation(s)
- Hiromichi Tamaki
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, 9500 Euclid Avenue, A50, Cleveland, OH 44195, USA
| | - Soumya Chatterjee
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, 9500 Euclid Avenue, A50, Cleveland, OH 44195, USA
| | - Carol A Langford
- Department of Rheumatic and Immunologic Diseases, Center for Vasculitis Care and Research, Cleveland Clinic, 9500 Euclid Avenue, A50, Cleveland, OH 44195, USA.
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Asano Y, Ihn H, Jinnin M, Tamaki Z, Tamaki K, Sato S. Serum levels of matrix metalloproteinase-13 in patients with eosinophilic fasciitis. J Dermatol 2014; 41:746-8. [DOI: 10.1111/1346-8138.12563] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 05/29/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Yoshihide Asano
- Department of Dermatology; University of Tokyo Graduate School of Medicine; Tokyo Japan
| | - Hironobu Ihn
- Department of Dermatology & Plastic and Reconstructive Surgery; Faculty of Medical and Pharmaceutical Sciences; Kumamoto University; Kumamoto Japan
| | - Masatoshi Jinnin
- Department of Dermatology & Plastic and Reconstructive Surgery; Faculty of Medical and Pharmaceutical Sciences; Kumamoto University; Kumamoto Japan
| | - Zenshiro Tamaki
- Department of Dermatology; University of Tokyo Graduate School of Medicine; Tokyo Japan
| | - Kunihiko Tamaki
- Department of Dermatology; University of Tokyo Graduate School of Medicine; Tokyo Japan
| | - Shinichi Sato
- Department of Dermatology; University of Tokyo Graduate School of Medicine; Tokyo Japan
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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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Canady J, Karrer S, Fleck M, Bosserhoff AK. Fibrosing connective tissue disorders of the skin: molecular similarities and distinctions. J Dermatol Sci 2013; 70:151-8. [PMID: 23631956 DOI: 10.1016/j.jdermsci.2013.03.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 02/28/2013] [Accepted: 03/08/2013] [Indexed: 02/08/2023]
Abstract
A variety of fibrosing connective tissue disorders of the skin have been described. They all share a characteristic activation of fibroblasts resulting in excessive production and deposition of extracellular matrix whereas their etiologies, incidence rates and clinical appearances differ dramatically in part. As effective treatment options are still not on hand, the understanding of cutaneous fibrogenesis needs to be improved. This review focuses on the molecular differences and similarities of the major fibrosing skin disorders namely systemic sclerosis, localized scleroderma, keloid and hypertrophic scars, Eosinophilic fasciitis, Lichen sclerosus and graft-versus-host-disease. Abnormalities in ECM turnover and the impact of matrix-metalloproteases were closely examined. It could be concluded, that besides increased collagen synthesis, modified ECM degradation is an as important factor in cutaneous fibrogenesis. The influence of immune components such as HLA haplotypes and the production of auto-antibodies is crucial for some of the diseases, but not decisive for skin fibrosis in general. A great number of cytokines was reported to be differentially regulated in the respective disorders among whom the components of the gp130/STAT3 signaling pathway seem to be of pivotal importance. Furthermore, the role of miRNAs in the pathogenesis of fibrosing connective tissue diseases of the skin was analyzed according to the current state of knowledge. In summary, this review gives an explicit overview of the various molecular mechanisms leading to fibrosis in the skin and the underlying connective tissue and reveals the most promising targets for future therapeutic approaches.
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Affiliation(s)
- Johanna Canady
- Institute of Pathology, Department for Molecular Pathology, University of Regensburg, Franz-Josef Strauss Allee 11, Regensburg, Germany
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de Masson A, Bouaziz JD, de Latour RP, Benhamou Y, Moluçon-Chabrot C, Bay JO, Laquerrière A, Picquenot JM, Michonneau D, Leguy-Seguin V, Rybojad M, Bonnotte B, Jardin F, Lévesque H, Bagot M, Socié G. Severe aplastic anemia associated with eosinophilic fasciitis: report of 4 cases and review of the literature. Medicine (Baltimore) 2013; 92:69-81. [PMID: 23429351 PMCID: PMC4553982 DOI: 10.1097/md.0b013e3182899e78] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Diffuse eosinophilic fasciitis (Shulman disease) is a rare sclerodermiform syndrome that, in most cases, resolves spontaneously or after corticosteroid therapy. It has been associated with hematologic disorders, such as aplastic anemia. The clinical features and long-term outcomes of patients with eosinophilic fasciitis and associated aplastic anemia have been poorly described. We report the cases of 4 patients with eosinophilic fasciitis and associated severe aplastic anemia. For 3 of these patients, aplastic anemia was refractory to conventional immunosuppressive therapy with antithymocyte globulin and cyclosporine. One of the patients received rituximab as a second-line therapy with significant efficacy for both the skin and hematologic symptoms. To our knowledge, this report is the first to describe rituximab used to treat eosinophilic fasciitis with associated aplastic anemia. In a literature review, we identified 19 additional cases of eosinophilic fasciitis and aplastic anemia. Compared to patients with isolated eosinophilic fasciitis, patients with eosinophilic fasciitis and associated aplastic anemia were more likely to be men (70%) and older (mean age, 56 yr; range, 18-71 yr). Corticosteroid-containing regimens improved skin symptoms in 5 (42%) of 12 cases but were ineffective in the treatment of associated aplastic anemia in all but 1 case. Aplastic anemia was profound in 13 cases (57%) and was the cause of death in 8 cases (35%). Only 5 patients (22%) achieved long-term remission (allogeneic hematopoietic stem cell transplantation: n = 2; cyclosporine-containing regimen: n = 2; high-dose corticosteroid-based regimen: n = 1).
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Affiliation(s)
- Adèle de Masson
- From Université Paris Diderot, Sorbonne Paris Cité; AP-HP; Service de Dermatologie (AdM, JDB, MR, MB) and Service de Greffe de Moëlle et Centre de Référence Maladies Rares des Aplasies Médullaires (RPdL, DM, GS), Hôpital Saint Louis, Paris; Service de Médecine Interne (YB, HL) and Service d’Anatomopathologie (AL), Hôpital Charles-Nicolle, Rouen; Service d’Hématologie (CMC, JOB), Hôpital Estaing, Clermont-Ferrand; Service d’Anatomopathologie (JMP) and Service d’Hématologie (FJ), Centre Henri Becquerel, Rouen; and Service de Médecine Interne et Immunologie Clinique (VLS, BB), Hôpital Le Bocage, Dijon; France
| | - Jean-David Bouaziz
- From Université Paris Diderot, Sorbonne Paris Cité; AP-HP; Service de Dermatologie (AdM, JDB, MR, MB) and Service de Greffe de Moëlle et Centre de Référence Maladies Rares des Aplasies Médullaires (RPdL, DM, GS), Hôpital Saint Louis, Paris; Service de Médecine Interne (YB, HL) and Service d’Anatomopathologie (AL), Hôpital Charles-Nicolle, Rouen; Service d’Hématologie (CMC, JOB), Hôpital Estaing, Clermont-Ferrand; Service d’Anatomopathologie (JMP) and Service d’Hématologie (FJ), Centre Henri Becquerel, Rouen; and Service de Médecine Interne et Immunologie Clinique (VLS, BB), Hôpital Le Bocage, Dijon; France
| | | | | | | | | | | | | | | | | | | | | | | | | | - Martine Bagot
- From Université Paris Diderot, Sorbonne Paris Cité; AP-HP; Service de Dermatologie (AdM, JDB, MR, MB) and Service de Greffe de Moëlle et Centre de Référence Maladies Rares des Aplasies Médullaires (RPdL, DM, GS), Hôpital Saint Louis, Paris; Service de Médecine Interne (YB, HL) and Service d’Anatomopathologie (AL), Hôpital Charles-Nicolle, Rouen; Service d’Hématologie (CMC, JOB), Hôpital Estaing, Clermont-Ferrand; Service d’Anatomopathologie (JMP) and Service d’Hématologie (FJ), Centre Henri Becquerel, Rouen; and Service de Médecine Interne et Immunologie Clinique (VLS, BB), Hôpital Le Bocage, Dijon; France
| | - Gérard Socié
- From Université Paris Diderot, Sorbonne Paris Cité; AP-HP; Service de Dermatologie (AdM, JDB, MR, MB) and Service de Greffe de Moëlle et Centre de Référence Maladies Rares des Aplasies Médullaires (RPdL, DM, GS), Hôpital Saint Louis, Paris; Service de Médecine Interne (YB, HL) and Service d’Anatomopathologie (AL), Hôpital Charles-Nicolle, Rouen; Service d’Hématologie (CMC, JOB), Hôpital Estaing, Clermont-Ferrand; Service d’Anatomopathologie (JMP) and Service d’Hématologie (FJ), Centre Henri Becquerel, Rouen; and Service de Médecine Interne et Immunologie Clinique (VLS, BB), Hôpital Le Bocage, Dijon; France
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Chun JH, Lee KH, Sung MS, Park CJ. Two cases of eosinophilic fasciitis. Ann Dermatol 2011; 23:81-4. [PMID: 21738370 DOI: 10.5021/ad.2011.23.1.81] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Revised: 03/02/2010] [Accepted: 03/24/2010] [Indexed: 11/08/2022] Open
Abstract
Eosinophic fasciitis (EF) is an uncommon connective tissue disease characterized by scleroderma-like cutaneous changes, peripheral eosinophilia, hypergammaglobulinemia, and an elevated erythrocyte sedimentation rate (ESR). Typical histopathologic findings include chronic inflammatory infiltration affecting the deep fascia with lymphocytes, histiocytes, and occasionally eosinophils. We report two cases of EF, the first of which is a 36-year-old man with a tender brownish induration on both forearms, for 2 months. Histopathologic examination showed fibrotic fascia with a mixed inflammatory cell infiltration. The second case is a 52-year-old woman with a symmetrical painful swelling and skin induration on both forearms, for 4 months. A deep biopsy demonstrated chronic inflammatory cell infiltration and hyaline degeneration in the fascia. Increased signal intensity in the fascia and tendon sheath was shown on magnetic resonance imaging. In laboratory examination, mild eosinophilia was found in both cases. Both patients had a history of physical activity (weight training and excessive housework, respectively) and showed marked improvement with high doses of oral prednisolone for several months.
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Affiliation(s)
- Ji Hoon Chun
- Department of Dermatology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Naoui A, Bouslama K, Abdallah M, Hamzaoui S, Arbi T, Bahri F, M’zabi S, Harmel A, Ennafaa M, Ben Dridi M, M’rad S. Fasciite avec éosinophilie (syndrome de Shulman) : à propos de 11 patients. Rev Med Interne 2010; 31:535-9. [DOI: 10.1016/j.revmed.2010.03.344] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2009] [Revised: 01/14/2010] [Accepted: 03/26/2010] [Indexed: 10/19/2022]
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Boggio E, Indelicato M, Orilieri E, Mesturini R, Mazzarino MC, Campagnoli MF, Ramenghi U, Dianzani U, Chiocchetti A. Role of tissue inhibitor of metalloproteinases-1 in the development of autoimmune lymphoproliferation. Haematologica 2010; 95:1897-904. [PMID: 20595097 DOI: 10.3324/haematol.2010.023085] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Inherited defects decreasing function of the Fas death receptor cause autoimmune lymphoproliferative syndrome and its variant Dianzani's autoimmune lymphoproliferative disease. Analysis of the lymphocyte transcriptome from a patient with this latter condition detected striking over-expression of osteopontin and tissue inhibitor of metalloproteinases-1. Since previous work on osteopontin had detected increased serum levels in these patients, associated with variations of its gene, the aim of this work was to extend the analysis to tissue inhibitor of metalloproteinases-1. DESIGN AND METHODS Tissue inhibitor of metalloproteinases-1 levels were evaluated in sera and culture supernatants from patients and controls by enzyme-linked immunosorbent assay. Activation- and Fas-induced cell death were induced, in vitro, using anti-CD3 and anti-Fas antibodies, respectively. RESULTS Tissue inhibitor of metalloproteinases-1 levels were higher in sera from 32 patients (11 with autoimmune lymphoproliferative syndrome and 21 with Dianzani's autoimmune lymphoproliferative disease) than in 50 healthy controls (P<0.0001), unassociated with variations of the tissue inhibitor of metalloproteinases-1 gene. Both groups of patients also had increased serum levels of osteopontin. In vitro experiments showed that osteopontin increased tissue inhibitor of metalloproteinases-1 secretion by peripheral blood monocytes. Moreover, tissue inhibitor of metalloproteinases-1 significantly inhibited both Fas- and activation-induced cell death of lymphocytes. CONCLUSIONS These data suggest that high osteopontin levels may support high tissue inhibitor of metalloproteinases-1 levels in autoimmune lymphoproliferative syndrome and Dianzani's autoimmune lymphoproliferative disease, and hence worsen the apoptotic defect in these diseases.
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Affiliation(s)
- Elena Boggio
- Department of Medical Sciences, Interdisciplinary Research Center of Autoimmune Diseases, A AvogadroUniversity of Eastern Piedmont, Novara, Italy
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Antic M, Lautenschlager S, Itin PH. Eosinophilic fasciitis 30 years after - what do we really know? Report of 11 patients and review of the literature. Dermatology 2006; 213:93-101. [PMID: 16902285 DOI: 10.1159/000093847] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2005] [Accepted: 02/16/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Eosinophilic fasciitis (EF) is a rare fibrosing disorder associated with peripheral eosinophilia and scleroderma-like induration of the distal extremities which affects substantially quality of life. Although the disease has been described 30 years ago, the etiology and pathomechanisms are still obscure, and consensus for therapy is lacking. Numerous case reports of patients with EF exist but series are scarce. PATIENTS AND METHODS Eleven patients with EF from the Department of Dermatology, Kantonsspital Aarau, the University Hospital Basel and the Outpatient Clinic of Dermatology, Triemli Hospital Zurich, Switzerland, were retrospectively studied. RESULTS In 4 patients the initial diagnosis was not recognized by the referring nondermatologists. The median age was 55 years, excluding the youngest patient ever diagnosed with EF (age = 1 year). All patients showed an induration of the skin, which led to painful contractures in the joints in 3 cases. All but 2 patients demonstrated edema. A slight predominance of the upper extremities was observed. Sclerodactyly was noticed in 1 patient. Three patients reported an initial trauma at the affected site. Two patients were tested positive for borreliosis. One patient subsequently developed aplastic anemia and Hashimoto thyroiditis. Visceral or extracutaneous involvement was absent. Eight patients had a full or partial recovery under corticosteroids whereas in 2, improvement could be achieved only with cyclosporine, azathioprine or cyclophosphamide. CONCLUSIONS The diagnosis of EF can be established by clinical, laboratory and histological findings. In general, corticosteroids are highly efficacious in EF and only a minority of patients need other immunosuppressive or cytostatic drugs.
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Affiliation(s)
- Milos Antic
- Department of Internal Medicine, General Hospital Waid, Zurich, Switzerland
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Abstract
Excessive extracellular matrix (ECM) deposition in the skin, lung, and other organs is a hallmark of systemic sclerosis (SSc). The pathogenesis of SSc is still poorly understood, but increasing evidence suggests that various cytokines such as transforming growth factor (TGF)-beta and their signaling pathways are key mediators of tissue fibrosis as a consequence of ECM accumulation in the pathogenesis of fibrosis such as SSc. TGF-beta regulates diverse biologic activities including cell growth, cell death or apoptosis, cell differentiation, and ECM synthesis. TGF-beta is known to induce the expression of ECM proteins in mesenchymal cells, and to stimulate the production of protease inhibitors that prevent enzymatic breakdown of the ECM. This paper focuses on the possible role of ECM, various cytokines, especially TGF-beta signal transduction pathways in the pathogenesis of fibrosis in SSc.
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Affiliation(s)
- Hironobu Ihn
- Department of Dermatology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
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Trallero Araguas E, Selva O'Callaghan A, Simeón Aznar CP, Sanjurjo Golpe E, García-Patos V, Vilardell Tarrés M. Fascitis eosinofílica: estudio de 10 pacientes. Med Clin (Barc) 2005; 125:145-8. [PMID: 15989857 DOI: 10.1157/13076952] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Eosinophilic fasciitis is an uncommon scleroderma-like syndrome with unknown etiology and pathogenesis. We report the clinical manifestations and response to therapy in a series of patients diagnosed with eosinophilic fasciitis. PATIENTS AND METHOD The records of 10 eosinophilic fasciitis patients seen at our hospital between 1996-2004 were reviewed. RESULTS Five patients were males, ages ranged from 20 years to 67 years, with a mean of 59 years. Patients were followed for 33.4 (27.1) months (SD). Nailfold capillaroscopy was near normal in all patients. Only one patient had antinuclear antibody positivity, and another had an autoimmune thyroiditis. No significant relationship was detected between the eosinophil count and the extent of skin induration. The clinical course was inadequate and the treatment response poor in patients with spreading cutaneous induration (p = 0.008). These patients had more often ventilatory restriction and perimyositis. CONCLUSIONS Eosinophilic fasciitis does not always have a good prognosis. Ventilatory restriction, perimyositis and poor treatment response are not infrequent in a series of patients attended in a general hospital.
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