Diffuse eosinophilic fasciitis. A new syndrome or variant of Scleroderma?

Eosinophilic fasciitis: a rare skin sclerosis

Eosinophilic fasciitis (Schulman's syndrome) is a rare disease with specific clinical symptoms such as the groove sign which facilitate diagnosis. We report a typical case of eosinophilic fasciitis in an otherwise healthy 49-year-old man who presented with “prayer and groove signs”. Histological analysis showed sclerosis and eosinophilic infiltration of the fascia. The patient was successfully treated with systemic corticotherapy and Cyclosporine. A short review of the clinicopathological features of the lesions is presented.

Eosinophilic fasciitis: report of two cases and a systematic review of the literature dealing with clinical variables that predict outcome

We reported two patients with refractory eosinophilic fasciitis (EF) and provided a systematic review of the literature to determine the clinical variables associated with prognosis of EF. We enrolled 88 cases, whose clinical characteristics were analyzed by separating the patients into two or three groups based on outcome. The incidence of certain clinical and pathological features differed among the groups. In particular, the incidence of morphea-like skin lesions in patients with refractory fibrosis was significantly higher than in patients without refractory fibrosis (p = 0.003). Patients with morphea-like skin lesions were 1.9 times more likely to develop persistent fibrosis than patients without these lesions (95% confidence intervals, 1.5-2.5). A younger age (under 12 years) at onset was associated with a 1.6 times greater risk of residual fibrosis (95% confidence interval, 1.1-2.2). Trunk involvement was associated with a 1.4 times greater risk of residual fibrosis (95% confidence interval, 1.0-2.0). Histopathologically, the presence of dermal fibrosclerosis was associated with a 1.4 times greater risk of refractory fibrosis (95% confidence interval, 1.0-2.1). We consider these clinical characteristics, notably the presence of morphea-like skin lesions may be an important risk factor for developing residual fibrosis in EF patients.

Eosinophilic fasciitis: clinical spectrum and therapeutic response in 52 cases

The clinical course of 52 cases with eosinophilic fasciitis observed at the Mayo Clinic has been described. Cutaneous changes included pitting edema, peau d'orange, and induration, and may affect virtually any body surface area. In addition, localized morphea was present in 15 cases. Arthritis was observed in 21 patients; 29 patients had flexion contractures and 12 had carpal tunnel syndrome. Associated hematologic diseases were found in five patients; thrombocytopenia in two, myeloproliferative disorder in one, myelomonocytic leukemia in one, and chronic lymphocytic leukemia in one. Peripheral blood eosinophilia was noted in 33 of 52 patients, hypergammaglobulinemia was noted in 17 of 49, and elevated sedimentation rate was noted in 15 of 52. Nonspecific EMG changes were seen in 11 of 15 patients. None had clinical involvement of the kidneys, lungs, or heart. No significant association between any HLA-A, -B, or -DR and eosinophilic fasciitis was seen. Prednisone and hydroxychloroquine seemed equally beneficial in treatment; however, some cases showed spontaneous recovery, making evaluation of therapeutic efficacy difficult. Relapses occurred in some cases.

The fascia in systemic scleroderma

Diffuse fasciitis (DF) shares clinical and pathologic features with systemic (SS) and localized scleroderma. The distinct pathologic feature in DF is involvement of the deep fascia, but it is not known if these changes consistently occur in SS. In this study, ten patients with SS underwent deep biopsies for evaluation of the fascia. All cases showed typical dermal histologic findings of scleroderma, and five cases showed thickening and fibrosis of the fascia. This study provides evidence that fascial involvement is not distinctive of DF but may occur in SS. It appears that thickening of the fascia is another morphologic feature shared between DF and SS.

Generalized morphea with peripheral eosinophilia, fasciitis and myositis

The distinctions between eosinophilic fascitis (Shulman's syndrome) and scleroderma may sometimes be unclear. We describe a patient with generalized morphea who also had peripheral blood eosinophilia, fibrosis and inflammation of fascia, and hyper-globulinemia, features usually attributed to Shulman's syndrome. The latter diagnosis should be restricted to those patients whose history, clinical and laboratory findings, and response to therapy closely resemble Shulman's original description. Scleroderma and eosinophilic fasciitis may represent slightly differing aspects of the same disease spectrum, with a similar immunologic pathogenesis.