1
|
Barajas-McGahan M, Tuckfield L, Rice K, Patel R. Atypical Case of Toe-Walking and Hyperpigmented Rash in a 9-year-old Boy. Pediatr Rev 2024; 45:e19-e23. [PMID: 38821902 DOI: 10.1542/pir.2022-005761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/07/2023] [Accepted: 08/30/2023] [Indexed: 06/02/2024]
Affiliation(s)
- Maria Barajas-McGahan
- Valley Children's Pediatric Residency Program affiliated with Stanford School of Medicine, Madera, CA
- Valley Children's Healthcare, Madera, CA
| | - Lynnia Tuckfield
- Valley Children's Pediatric Residency Program affiliated with Stanford School of Medicine, Madera, CA
- Valley Children's Healthcare, Madera, CA
| | - Kerrilynn Rice
- Valley Children's Pediatric Residency Program affiliated with Stanford School of Medicine, Madera, CA
- Valley Children's Healthcare, Madera, CA
| | - Reshma Patel
- Valley Children's Pediatric Residency Program affiliated with Stanford School of Medicine, Madera, CA
- Valley Children's Healthcare, Madera, CA
| |
Collapse
|
2
|
Yamada T, Hashimoto E, Suzuki M, Hirose K. Joint Sparing: The Key to Unlocking Early Treatment Success in Eosinophilic Fasciitis. Cureus 2024; 16:e60076. [PMID: 38860063 PMCID: PMC11163252 DOI: 10.7759/cureus.60076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2024] [Indexed: 06/12/2024] Open
Abstract
Delayed diagnosis is recognized as a poor prognostic factor in eosinophilic fasciitis (EF). Elevated serum eosinophil counts, a minor criterion in the diagnostic standards, occur early in the disease course. However, signs such as the groove sign and orange-peel sign typically do not appear in the initial stages, posing challenges for early detection under the current diagnostic criteria. We report a case where the combination of "joint sparing" physical findings and elevated eosinophil counts facilitated early diagnosis and treatment. A 79-year-old woman presented with an acute onset of swelling in the upper and lower limbs. Physical examination revealed non-pitting edema with "joint sparing", and blood tests showed increased eosinophil counts. Contrast-enhanced MRI of the lower limbs showed post-contrast enhancement along the fascia, leading to a diagnosis of EF. The presence of non-pitting edema with "joint sparing" may be a valuable diagnostic indicator for EF. Furthermore, combining this with serum eosinophil counts can enable early diagnosis and treatment, potentially improving patient outcomes.
Collapse
Affiliation(s)
- Tatsuki Yamada
- Department of General Medicine and Primary Care, University of Tsukuba Hospital, Tsukuba, JPN
| | - Etaro Hashimoto
- Faculty of Medicine/Department of Primary Care and Medical Education, University of Tsukuba/University of Tsukuba Hospital, Tsukuba, JPN
| | - Masatsune Suzuki
- Department of Primary Care and Medical Education/Department of General Medicine and Primary Care, Faculty of Medicine, University of Tsukuba/University of Tsukuba Hospital, Tsukuba, JPN
| | - Kazuhito Hirose
- Department of General Medicine, Tsukuba Medical Center Hospital, Tsukuba, JPN
| |
Collapse
|
3
|
Cherim A, Bastian AE, Popp CG, Mihon MI, Efrem IC, Vreju AF, Ionescu RA. Eosinophilic fasciitis: unraveling the clinical tapestry of a rare case and review of literature. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2024; 65:341-347. [PMID: 39020550 PMCID: PMC11384037 DOI: 10.47162/rjme.65.2.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Abstract
Eosinophilic fasciitis (EF) remains a diagnostic challenge due to its rarity and resemblance to scleroderma. This case report aims to provide a cohesive exploration of EF's clinical nuances, emphasizing the importance of accurate diagnosis and effective management. A 52-year-old male developed bilateral forearm and calf hardening, along with erythema, pruritus, and pain four months prior to the presentation in our Clinic. The symptoms initially debuted bilaterally in the forearms and progressed to involve the calves, distal arms, and thighs. Clinical examination revealed symmetrical plaques on forearms and calves, featuring erythematous, hyper, and hypopigmented elements extending proximally, a positive "groove sign" and a moderate difficulty in knee joint flexion. Despite these findings, the patient was generally in good condition, without any other notable clinical signs. Initial laboratory findings showed slightly increased percentual eosinophil levels, elevated C-reactive protein (CRP), normal erythrocyte sedimentation rate (ESR), and negative antinuclear and scleroderma specific antibodies. Magnetic resonance imaging (MRI) demonstrated enhanced fascial signal and thickening while the fascia-muscle biopsy revealed marked edema and inflammatory lymphoplasmacytic infiltrate, consistent with the diagnosis of EF. The patient showed a favorable response to systemic corticosteroids. EF predominantly affects males aged 30 to 60 and is characterized by a sudden onset and unclear etiological factors. Differential diagnosis requires careful exclusion of scleroderma and other mimicking conditions. Diagnostic modalities such as skin-muscle biopsy and MRI reveal characteristic findings like inflammatory infiltrate and fascial thickening. Accurate diagnosis and differentiation from scleroderma are crucial, with early intervention involving glucocorticoids and immunosuppressive agents improving long-term outcomes.
Collapse
Affiliation(s)
- Aifer Cherim
- Department of Internal Medicine - Medical Semiology, Faculty of Dentistry, University of Medicine and Pharmacy of Craiova, Romania; ,
| | | | | | | | | | | | | |
Collapse
|
4
|
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.
Collapse
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.
| |
Collapse
|
5
|
Gerritzen N, Ziob J, Brossart P, Schäfer VS. [Imaging of eosinophilic fasciitis in ultrasound and MRI (magnetic resonance imaging): a case report]. Z Rheumatol 2024; 83:134-138. [PMID: 35575828 PMCID: PMC10902094 DOI: 10.1007/s00393-022-01207-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/26/2022]
Abstract
Eosinophilic fasciitis (EF, also known as Shulman syndrome) is an uncommon connective tissue disease characterized by inflammatory thickening of the fasciae as well as swelling and hardening of the skin. It mostly affects the lower extremities. Swollen and indurated skin, together with the groove sign, are typical clinical signs. So far, biopsy evidence of inflammation and thickening of the fascia has been the gold standard for diagnosis. Magnetic resonance imaging (MRI) is mentioned in the literature as an alternative method for confirming the diagnosis. We present a case of asymmetric EF in a 54-year-old German male. He came with painful induration of the right forearm, with a characteristic groove sign and limitation of motion of the right hand. The blood count revealed eosinophilia with 0.57 G/l or 9.6% (normal: 0.05-0.5 G/l and 0.5-5.5%), ANA and ENA were negative. The diagnosis was confirmed histologically and we were able to detect a thickened fascia in MRI and ultrasound imaging. The EF also appeared in the left lateral malleolus during the course of the illness. Treatment was carried out with prednisolone and methotrexate.
Collapse
Affiliation(s)
- Nicolas Gerritzen
- Medizinische Klinik III, Onkologie, Hämatologie, Rheumatologie und klinische Immunologie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland
| | - Jana Ziob
- Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Peter Brossart
- Medizinische Klinik III, Onkologie, Hämatologie, Rheumatologie und klinische Immunologie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland
| | - Valentin S Schäfer
- Medizinische Klinik III, Onkologie, Hämatologie, Rheumatologie und klinische Immunologie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland.
| |
Collapse
|
6
|
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.
Collapse
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.
| |
Collapse
|
7
|
Boussaa H, Kamoun M, Miladi S, Makhlouf Y, Abdelghani KB, Fazaa A, Laatar A. The first case of SARS-CoV-2-induced eosinophilic fasciitis. Mod Rheumatol Case Rep 2023; 8:224-228. [PMID: 37902576 DOI: 10.1093/mrcr/rxad063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/01/2023] [Accepted: 10/06/2023] [Indexed: 10/31/2023]
Abstract
Eosinophilic fasciitis (EF), also known as Shulman syndrome, is a rare auto-immune fibrosing disorder of the fascia. Etiopathogeny of EF is still unclear. Nowadays, it is widely known that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may induce hyper-stimulation of the immune system. Several cases with fasciitis and rhabdomyolysis induced by coronavirus disease 2019 vaccines have been reported in the literature. Herein, we report the first case of EF possibly triggered by SARS-CoV-2 infection. A 45-year-old Tunisian woman, with no medical history, presented to our department with severe widespread muscle pain noticed one month after a SARS-CoV-2 infection. Physical examination showed an induration of the skin and subcutaneous tissue of the arms, forearms and legs with a restricted joint mobility. The level of eosinophils was 430 E/mm3 (6.1%) [1-4%]. Electromyography and creatine kinase levels were normal. Myositis-related antibodies were negative. Magnetic resonance imaging of the left arm showed high-intensity signal and thickness of the fascia without evidence of muscle or bone involvement. A muscular biopsy from the right deltoid showed thickening and inflammation of the fascia. The patient received intraveinous injections of 1000 mg of methylprednisolone for 3 days with an oral relay of 1 mg/kg per day of prednisone equivalent during 4 weeks. At one-month follow-up, a significant improvement of the skin induration and myalgia was observed, with a disappearance of the biological inflammatory syndrome. This brief report suggests a potential link between SARS-CoV-2 infection and new-onset of auto-immune fasciitis.
Collapse
Affiliation(s)
- Hiba Boussaa
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Rheumatology Department, Mongi Slim University Hospital, Tunis, Tunisia
| | - Mariem Kamoun
- Rheumatology Department, Mongi Slim University Hospital, Tunis, Tunisia
| | - Saoussen Miladi
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Rheumatology Department, Mongi Slim University Hospital, Tunis, Tunisia
| | - Yasmine Makhlouf
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Rheumatology Department, Mongi Slim University Hospital, Tunis, Tunisia
| | - Kawther Ben Abdelghani
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Rheumatology Department, Mongi Slim University Hospital, Tunis, Tunisia
| | - Alia Fazaa
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Rheumatology Department, Mongi Slim University Hospital, Tunis, Tunisia
| | - Ahmed Laatar
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Rheumatology Department, Mongi Slim University Hospital, Tunis, Tunisia
| |
Collapse
|
8
|
Posso-Osorio I, Vargas-Potes CJ, Mejía M, Cañas CA. Eosinophil-related diseases during treatment with glucagon-like peptide one receptor (GLP-1 RA): a case report and review of the literature. Clin Rheumatol 2023; 42:2501-2506. [PMID: 37199890 PMCID: PMC10412476 DOI: 10.1007/s10067-023-06612-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] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/14/2023] [Accepted: 04/21/2023] [Indexed: 05/19/2023]
Abstract
Glucagon-like peptide one-receptor agonists (GLP-1 RA) are drugs that differ in their pharmacological composition and homology to human GLP-1 and are used most frequently for the treatment of type 2 diabetes and weight loss. There are isolated reports of eosinophilic adverse reactions associated with GLP-1 RA. We present the case of a 42-year-old female patient who, after starting weekly subcutaneous semaglutide, developed eosinophilic fasciitis with favorable clinical evolution after the discontinuation of semaglutide and the initiation of immunosuppression. A review of the eosinophilic adverse events that have been previously reported with GLP-1 RA is provided.
Collapse
Affiliation(s)
- Iván Posso-Osorio
- Universidad Icesi, Facultad de Ciencias de la Salud, Cali, 760031, Colombia
- Unit of Rheumatology, Fundación Valle del Lili, Unidad de Reumatología, Cali, 760031, Colombia
- Universidad Icesi, CIRAT: Centro de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Cali, 760031, Colombia
| | | | - Mauricio Mejía
- Fundación Valle del Lili, Unidad de Radiología, Cali, 760031, Colombia
| | - Carlos A Cañas
- Universidad Icesi, Facultad de Ciencias de la Salud, Cali, 760031, Colombia.
- Unit of Rheumatology, Fundación Valle del Lili, Unidad de Reumatología, Cali, 760031, Colombia.
- Universidad Icesi, CIRAT: Centro de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Cali, 760031, Colombia.
| |
Collapse
|
9
|
Wosiak A, Biernacka-Zielińska M, Roszkiewicz J, Smolewska E. Diffuse fasciitis with eosinophilia in boys: a case-based review. Rheumatol Int 2023; 43:1755-1764. [PMID: 37316632 PMCID: PMC10348932 DOI: 10.1007/s00296-023-05362-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/05/2023] [Indexed: 06/16/2023]
Abstract
Diffuse fasciitis with eosinophilia (EF) is a rare condition classified as a part of the connective tissue disorders. The clinical presentation of this condition can be diverse, however the main symptoms include symmetrical swelling and hardening of distal parts of limbs accompanied by peripheral eosinophilia. The diagnostic criteria are not specified. In inconclusions cases Magnetic Resonance Imaging (MRI) and skin to muscle biopsy may be useful. The pathogenesis and ethiology remain unknown, but extensive physical exertion, certain infectious factors, such as Borrelia burgdorferi, or medications may serve as a trigger. EF affects equally women and men, mainly in their middle age, however the disease can occur at any age. The standard therapy contents gluccocorticosteroids. As a second-line treatment, methotrexate is usually chosen. In this article we compare world reports of EF in paediatric patients with the cases of two adolescent male patients recently hospitalized in the Department of Paediatric Rheumatology.
Collapse
Affiliation(s)
- Agnieszka Wosiak
- Department of Paediatric Cardiology and Rheumatology, Central Clinical Hospital of the Medical University of Lodz, 36/50 Sporna St., 91-738, Lodz, Poland.
| | - Małgorzata Biernacka-Zielińska
- Department of Paediatric Cardiology and Rheumatology, Central Clinical Hospital of the Medical University of Lodz, 36/50 Sporna St., 91-738, Lodz, Poland
| | - Justyna Roszkiewicz
- Department of Paediatric Cardiology and Rheumatology, Central Clinical Hospital of the Medical University of Lodz, 36/50 Sporna St., 91-738, Lodz, Poland
| | - Elżbieta Smolewska
- Department of Paediatric Cardiology and Rheumatology, Central Clinical Hospital of the Medical University of Lodz, 36/50 Sporna St., 91-738, Lodz, Poland
| |
Collapse
|
10
|
Lan TY, Wang ZH, Kong WP, Wang JP, Zhang N, Jin DE, Luo J, Tao QW, Yan ZR. Eosinophilic fasciitis difficult to differentiate from scleroderma: A case report. World J Clin Cases 2023; 11:3092-3098. [PMID: 37215414 PMCID: PMC10198086 DOI: 10.12998/wjcc.v11.i13.3092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 03/02/2023] [Accepted: 03/27/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Eosinophilic fasciitis (EF) is a rare connective tissue disease that can cause swelling and sclerosis of the extremities, and special attention is needed to differentiate EF from systemic sclerosis. Misdiagnosis or omission markedly delays treatment of EF, and severe skin sclerosis in advanced stages can cause joint contracture and tendon retraction, worsening the patient's prognosis and quality of life.
CASE SUMMARY We report a case of EF in a young woman diagnosed by tissue biopsy, confirming the difficulty of differential diagnosis with scleroderma.
CONCLUSION Focusing on skin manifestations, completing tissue biopsy and radiography can help diagnose EF effectively. Clinicians should enhance their understanding of the differences between EF and scleroderma, and early diagnosis and standardized treatment can improve the prognosis of patients with EF.
Collapse
Affiliation(s)
- Tian-Yi Lan
- Graduate College, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Zi-Han Wang
- Graduate College, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Wei-Ping Kong
- Traditional Chinese Medicine Department of Rheumatism, China-Japan Friendship Hospital, Beijing 100029, China
| | - Jin-Ping Wang
- Traditional Chinese Medicine Department of Rheumatism, China-Japan Friendship Hospital, Beijing 100029, China
| | - Nan Zhang
- Traditional Chinese Medicine Department of Rheumatism, China-Japan Friendship Hospital, Beijing 100029, China
| | - Di-Er Jin
- Traditional Chinese Medicine Department of Rheumatism, China-Japan Friendship Hospital, Beijing 100029, China
| | - Jing Luo
- Traditional Chinese Medicine Department of Rheumatism, China-Japan Friendship Hospital, Beijing 100029, China
| | - Qing-Wen Tao
- Traditional Chinese Medicine Department of Rheumatism, China-Japan Friendship Hospital, Beijing 100029, China
| | - Ze-Ran Yan
- Traditional Chinese Medicine Department of Rheumatism, China-Japan Friendship Hospital, Beijing 100029, China
| |
Collapse
|
11
|
Chen Z, Wasti B, Shang Y, Jia A, Xiang X, Ouyang R. Clinical characteristics and risk factors of patients with eosinophilic fasciitis associated with pleural effusion. Sci Rep 2023; 13:5452. [PMID: 37012347 PMCID: PMC10070614 DOI: 10.1038/s41598-023-32678-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/31/2023] [Indexed: 04/05/2023] Open
Abstract
To investigate the risk factors of eosinophilic fasciitis (EF) associated with pleural effusion (PE). A retrospective analysis was performed on 22 patients with EF diagnosed by skin biopsy in our hospital, and they were divided into EF-PE and EF according to chest computed tomography examination. The clinical characteristics, clinical manifestations, comorbidities and laboratory test indicators of the two groups were collected and compared, and the risk factors for occurring PE in patients with EF were determined by multivariate logistic regression analysis. Among 22 patients with EF, 8 had PE. The age, course of disease, incidence of fever, weight loss, cough and shortness of breath, pulmonary infection, hypothyroidism, hydronephrosis and kidney stone, swelling rate of small vascular endothelial cells, consolidation shadows, C-reactive protein and thyroid stimulating hormone in EF-PE group were higher than those in EF group, while free triiodothyronine and thyroxine were lower than those in EF group. Age, fever, shortness of breath, C-reactive protein, ESR, thyroid stimulating hormone, pulmonary infection, hypothyroidism, hydronephrosis, kidney stones, swollen small vascular endothelial cells and chest CT consolidation shadows were identified as risk factors for happening PE in patients with EF, while free triiodothyronine and free thyroxine were identified as protective factors against PE in patients with EF. The incidence of EF-PE was 36.36% in this study. Advanced age, high C-reactive protein, ESR, thyroid stimulating hormone, incidence of fever, shortness of breath, pulmonary infection, hydronephrosis, kidney stones, swollen small vascular endothelial cells, chest CT consolidation shadows, and low free triiodothyronine and thyroxine suggest that patients with EF are significantly at increased risk of PE.
Collapse
Affiliation(s)
- Zhifeng Chen
- Department of Respiratory Medicine, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China
| | - Binaya Wasti
- Department of Respiratory Medicine, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China
| | - Yulin Shang
- Ophthalmology and Otorhinolaryngology, Zigui County Traditional Chinese Medicine Hospital, 30 Pinghu Avenue, Zigui, 443600, Hubei, China
| | - Aijun Jia
- Department of the Third Emergency of Yuelushan Hospital District, Hunan Provincial People's Hospital, No.90 Pingchuan Road, Changsha, 410006, Hunan, China
| | - Xudong Xiang
- Department of Emergency, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China
| | - Ruoyun Ouyang
- Department of Respiratory Medicine, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China.
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Zuelgaray E, Chevret S, Jachiet M, Cacoub P, Kahn JE, Groh M, Granel B, Scafi M, Geffray L, Chasset F, Gatfosse M, Mekinian A, Lioger B, Mahr A, Gaches F, Michaud M, Ludot I, Cordoliani F, de Masson A, Cassius C, Retornaz F, Audemard-Verger A, Lartigau-Roussin C, Roriz M, Chaigne B, Pallure V, Marie I, Castel B, Loustau V, Chiche L, Gavand PE, Cathebras P, Barete S, Frances C, Brenaut E, Allenbach Y, Benveniste O, Noel N, Urbanski G, Hinschberger O, Bessis D, Bagot M, Bouaziz JD, Sène D. Trunk involvement and peau d'orange aspect are poor prognostic factors in eosinophilic fasciitis (Shulman disease): A multicenter retrospective study of 119 patients. J Am Acad Dermatol 2023; 88:160-163. [PMID: 33188872 DOI: 10.1016/j.jaad.2020.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/05/2020] [Accepted: 11/05/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Elina Zuelgaray
- Service de Dermatologie, Université de Paris, Hôpital Saint-Louis, Paris, France
| | - Sylvie Chevret
- Service de Biostatistique et Information Médicale, Université de Paris, Hôpital Saint-Louis, Paris, France
| | - Marie Jachiet
- Service de Dermatologie, Université de Paris, Hôpital Saint-Louis, Paris, France
| | - Patrice Cacoub
- Département de Médecine Interne et d'Immunologie clinique, Sorbonne-Université, Hôpital de la Pitié-Salpêtrière, APHP, Paris, France
| | - Jean-Emmanuel Kahn
- Centre National de Référence des Syndromes Hyperéosinophiliques, Service de Médecine Interne, Hôpital Foch, Suresnes, France
| | - Matthieu Groh
- Centre National de Référence des Syndromes Hyperéosinophiliques, Service de Médecine Interne, Hôpital Foch, Suresnes, France
| | - Brigitte Granel
- Service de Médecine Interne et d'Immunologie clinique, Hôpital Nord, Marseille, France
| | - Manon Scafi
- Service de Médecine Interne et d'Immunologie clinique, Hôpital Nord, Marseille, France
| | - Loïk Geffray
- Service de Médecine Interne et d'Immunologie clinique, Centre Hospitaliser de Lisieux, Lisieux, France
| | - François Chasset
- Service de Dermatologie, Université de Paris, Hôpital Tenon, Paris, France
| | - Marc Gatfosse
- Service de Médecine Interne et d'Immunologie clinique, Sorbonne Université, Hôpital Saint-Antoine, Paris, France
| | - Arsène Mekinian
- Service de Médecine Interne et d'Immunologie clinique, Sorbonne Université, Hôpital Saint-Antoine, Paris, France
| | - Bertrand Lioger
- Unité de Médecine Interne et Maladies systémiques, Université de Paris, Hôpital Saint-Louis, Paris, France
| | - Alfred Mahr
- Unité de Médecine Interne et Maladies systémiques, Université de Paris, Hôpital Saint-Louis, Paris, France
| | - Francis Gaches
- Service de Médecine Interne et d'Immunologie clinique, Hôpital Joseph Ducuing, Toulouse, France
| | - Martin Michaud
- Service de Médecine Interne et d'Immunologie clinique, Hôpital Joseph Ducuing, Toulouse, France
| | - Isabelle Ludot
- Service de Rhumatologie, Clinique Pasteur, Toulouse, France
| | - Florence Cordoliani
- Service de Dermatologie, Université de Paris, Hôpital Saint-Louis, Paris, France
| | - Adèle de Masson
- Service de Dermatologie, Université de Paris, Hôpital Saint-Louis, Paris, France
| | - Charles Cassius
- Service de Dermatologie, Université de Paris, Hôpital Saint-Louis, Paris, France
| | - Frédérique Retornaz
- Unité de soins et de recherche en médecine interne et de maladies infectieuses, Hôpital Européen, Marseille, France
| | - Alexandra Audemard-Verger
- Service de Médecine Interne et d'Immunologie clinique, Centre Hospitalo-Universitaire Côte de Nacre, Caen, France
| | - Céline Lartigau-Roussin
- Service de Médecine Interne et d'Immunologie clinique, Centre Hospitalier Ouest Réunion, Saint Paul, France
| | - Mélanie Roriz
- Service de Médecine Interne et d'Immunologie clinique, Hôpital Bichat, Paris, France
| | - Benjamin Chaigne
- Service de Médecine Interne et d'Immunologie clinique, Hôpital Cochin, Paris, France
| | - Valérie Pallure
- Service de Dermatologie, Centre Hospitalier de Perpignan, Perpignan, France
| | - Isabelle Marie
- Service de Médecine Interne et d'Immunologie clinique, Centre Hospitalo-Universitaire de Rouen, Rouen, France
| | - Brice Castel
- Service de Médecine Interne et d'Immunologie clinique, Centre Hospitalier de Lourdes, Lourdes, France
| | - Valentine Loustau
- Service de Médecine Interne et d'Immunologie clinique, Centre Hospitalier Alpes Léman, Contamine-sur-Avre, France
| | - Laurent Chiche
- Unité de soins et de recherche en médecine interne et de maladies infectieuses, Hôpital Européen, Marseille, France
| | - Pierre-Edouard Gavand
- Service de Médecine Interne et d'Immunologie clinique, Clinique Rhena, Strasbourg, France
| | - Pascal Cathebras
- Service de Médecine Interne et d'Immunologie clinique, Centre Hospitalo-Universitaire de Saint Etienne, Hôpital Nord, Saint-Etienne, France
| | - Stéphane Barete
- Service de Dermatologie, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Camille Frances
- Service de Dermatologie, Université de Paris, Hôpital Tenon, Paris, France
| | - Emilie Brenaut
- Service de Dermatologie, Centre Hospitalo-Universitaire Morvan, Brest, France
| | - Yves Allenbach
- Département de Médecine Interne et d'Immunologie clinique, Sorbonne-Université, Hôpital de la Pitié-Salpêtrière, APHP, Paris, France
| | - Olivier Benveniste
- Département de Médecine Interne et d'Immunologie clinique, Sorbonne-Université, Hôpital de la Pitié-Salpêtrière, APHP, Paris, France
| | - Nicolas Noel
- Service de Médecine Interne et d'Immunologie clinique, Hôpital Bicêtre, Kremlin-Bicêtre, France
| | - Geoffrey Urbanski
- Service de Médecine Interne et d'Immunologie clinique, Centre Hospitalo-Universitaire d'Angers, Angers, France
| | - Olivier Hinschberger
- Service de Médecine Interne et d'Immunologie clinique, Hôpital Emile Muller, Mulhouse, France
| | - Didier Bessis
- Service de Dermatologie, Hôpital Saint Eloi, Montpellier, France
| | - Martine Bagot
- Service de Dermatologie, Université de Paris, Hôpital Saint-Louis, Paris, France
| | - Jean-David Bouaziz
- Service de Dermatologie, Université de Paris, Hôpital Saint-Louis, Paris, France.
| | - Damien Sène
- Service de Médecine Interne et d'Immunologie clinique, Hôpital Lariboisière, Paris, France
| | | | | | | |
Collapse
|
14
|
Chaigne B, Tieu A, Beeker N, Zuelgaray E, Bouaziz JD, Sène D, Dupin N, Mouthon L. Cluster analysis reveals eosinophilia and fibrosis as poor prognostic markers in 128 patients with eosinophilic fasciitis. J Am Acad Dermatol 2022; 87:997-1005. [PMID: 35995088 DOI: 10.1016/j.jaad.2022.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/11/2022] [Accepted: 08/09/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Eosinophilic fasciitis (EF) is an extremely rare disease with polymorphic presentation and prognosis. OBJECTIVE To further investigate EF features. METHODS We performed a retrospective multicentre study of EF patients from 2013 to 2019, clustered patients using multivariate correspondence analysis (MCA) and sought prognosis factors. RESULTS One hundred twenty-eight patients were included. Sixty-nine (50%) patients had skin sclerosis and eosinophil count was increased in 71 (55%) patients. MCA identified 3 clusters: a "mild", a "late-onset and hypereosinophilic" and a "fibrotic" cluster. Of 109 patients followed-up for more than one year, 49 (45%) presented a relapse and 48 (44%) had sequelae. Multivariate analysis revealed that eosinophilia (hazard ratio (HR)=1.56; p=0.02) and fibrosis (HR=4.02; p=0.002) were predictive factors of relapse, whereas edema (odds ratio (OR)=0.31; p=0.03), relapse (OR=3.00; p=0.04) and fibrosis (OR=1) were predictive factors of sequelae. Following relapse, treatment modifications consisted of an increase in glucocorticoids in 40 (82%) patients and addition of methotrexate in 31 (63%) patients. These modifications led to clinical improvement and glucocorticoid withdrawal in 37 (76%) and 22 (45%) patients, respectfully. LIMITATIONS Retrospective study. CONCLUSION EF patients can be divided into three homogenous clusters, which, along with fibrosis and eosinophilia, are prognosis factors of relapse and sequelae.
Collapse
Affiliation(s)
- Benjamin Chaigne
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France; APHP-CUP, Hôpital Cochin, Université de Paris, Paris, France.
| | - Ashley Tieu
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France; APHP-CUP, Hôpital Cochin, Université de Paris, Paris, France
| | | | - Elina Zuelgaray
- Service de Dermatologie, Hôpital Saint-Louis, Université de Paris, Paris, France
| | - Jean-David Bouaziz
- Service de Dermatologie, Hôpital Saint-Louis, Université de Paris, Paris, France
| | - Damien Sène
- Département de Médecine Interne et d'Immunologie clinique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Nicolas Dupin
- APHP-CUP, Hôpital Cochin, Université de Paris, Paris, France; Service de Dermatologie, Hôpital Cochin, Université de Paris, Paris, France
| | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France; APHP-CUP, Hôpital Cochin, Université de Paris, Paris, France
| |
Collapse
|
15
|
Blackmond N, Kanke J, Brown K, Weitzman R. Eosinophilic Fasciitis: A Rare and Challenging Diagnosis in a Free Clinic Setting. Cureus 2022; 14:e25668. [PMID: 35812539 PMCID: PMC9255255 DOI: 10.7759/cureus.25668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2022] [Indexed: 11/17/2022] Open
Abstract
Eosinophilic fasciitis (EF) is a rare ailment that affects the immune system. Due to the rarity of this condition, there are few clear diagnostic criteria for clinicians to focus on. This may lead to significant delays in reaching a diagnosis and offering proper treatment, and patients may end up seeing multiple different specialists. This is especially true in a free clinic setting where continuity of care, follow-up, and specialist access are usually lacking. In this report, we describe a case of a 24-year-old white male who presented with sudden onset of redness, swelling, burning, and pain in the bilateral upper and lower extremities. Through arduous workup and testing, he was found to have increased eosinophils in peripheral blood, elevated levels of white blood cell count, increased C-reactive protein, and pathological changes in the tissue showing eosinophil and lymphocyte infiltration. We shed light on the relative rarity of this condition and its similar clinical characteristics to various dermatological/rheumatological disease processes. We also highlight how a free clinic can provide high-quality healthcare to bridge gaps in access to care by providing high-quality and broad specialist access while ensuring continuity of care.
Collapse
|
16
|
Haroon A, Tadros J, Smith EH. Eosinophilic Fasciitis with Concurrent Necrobiotic Granulomatous Dermatitis Related to Checkpoint Inhibition Therapy. JOURNAL OF IMMUNOTHERAPY AND PRECISION ONCOLOGY 2022; 5:48-51. [PMID: 35664087 PMCID: PMC9153248 DOI: 10.36401/jipo-21-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 12/02/2022]
Abstract
Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapeutics. However, loss of physiologic tolerance in few cases has triggered rare and novel immune-related adverse events (irAEs). Eosinophilic fasciitis, an infrequently reported diffuse scleroderma-like entity, has been associated with ICI therapy. We report a case of a patient with metastatic melanoma treated with nivolumab who developed eosinophilic fasciitis with concurrent granulomatous dermatitis and lymphadenitis, the latter of which mimicked melanoma recurrence radiographically. Furthermore, this patient had a severe presentation that subsequently proved to be treatment-resistant to both corticosteroid and steroid-sparing therapies. To our knowledge, eosinophilic fasciitis has not been reported concurrently with granulomatous dermatitis in literature. We provide a narrative of this case and a review of therapeutic approaches for severe or refractory irAEs. With the increasing popularity of ICI therapy, we believe it is essential for clinicians to identify novel irAEs and be aware of treatments as late recognition could prove fatal.
Collapse
Affiliation(s)
- Adeeb Haroon
- Department of Dermatology, University of Missouri, Columbia, MO, USA
| | - Joseph Tadros
- Department of Dermatology, University of Missouri, Columbia, MO, USA
| | - Emily H. Smith
- Department of Dermatology, University of Missouri, Columbia, MO, USA
| |
Collapse
|
17
|
Tognetti L, Marrocco C, Carraro A, Conticini E, Habougit C, Mariotti G, Cinotti E, Perrot JL, Rubegni P. UVA-1 phototherapy as adjuvant treatment for eosinophilic fasciitis: in vitro and in vivo functional characterization. Int J Dermatol 2021; 61:718-726. [PMID: 34881449 PMCID: PMC9299925 DOI: 10.1111/ijd.16003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/21/2021] [Accepted: 11/10/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Eosinophilic fasciitis (EF) is a rare autoimmune disease causing progressive induration of dermal, hypodermal, and muscularis fascia. The exact pathogenesis is yet to be fully understood, and a validated therapy protocol still lacks. We here aimed to realize a clinical-functional characterization of these patients. MATERIALS AND METHODS A total of eight patients (five males, 45 years average) were treated with adjuvant high-dose UVA-1 phototherapy (90 J/cm), after having received the standard systemic immunosuppressive protocol (oral methylprednisolone switched to methotrexate). Body lesion mapping, Localized Scleroderma Assessment Tool (LoSCAT), Dermatology Life Quality Index (DLQI), High-Resolution Ultrasound (HRUS) (13-17MHz), and ultra HRUS (55-70 MHz) were performed at each examination time taking specific anatomical points. Gene expression analysis at a molecular level and in vitro UVA-1 irradiation was realized on lesional fibroblasts primary cultures. RESULTS The LoSCAT and the DLQI showed to decrease significantly starting from the last UVA-1 session. A significant reduction in muscularis fascia thickness (-50% on average) was estimated starting from 3 months after the last UVA-1 session and maintained up to 12 months follow-up. Tissues was detected by HRUS. The UVA-1 in vitro irradiation of lesional skin sites cells appeared not to affect their viability. Molecular genes analysis revealed a significant reduction of IL-1ß and of TGF-ß genes after phototherapy, while MMPs 1,2,9 gene expression was enhanced. COMMENT These preliminary in vivo and in vitro findings suggest that UVA-1 phototherapy is a safe and useful adjuvant therapy able to elicit anti-inflammatory effects and stimulate tissue matrix digestion and remodeling at lesional sites.
Collapse
Affiliation(s)
- Linda Tognetti
- Dermatology Unit and Skin Bank Unit, Department of Clinical, Surgical and Neuro-sciences, University of Siena, Italy
| | - Camilla Marrocco
- Dermatology Unit and Skin Bank Unit, Department of Clinical, Surgical and Neuro-sciences, University of Siena, Italy
| | - Andrea Carraro
- Dermatology Unit and Skin Bank Unit, Department of Clinical, Surgical and Neuro-sciences, University of Siena, Italy
| | - Edoardo Conticini
- Rheumatology Unit, Department of Clinical, Surgical and Neuro-sciences, University of Siena, Italy
| | - Cyril Habougit
- Department of Pathology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Giancarlo Mariotti
- Dermatology Unit and Skin Bank Unit, Department of Clinical, Surgical and Neuro-sciences, University of Siena, Italy
| | - Elisa Cinotti
- Dermatology Unit and Skin Bank Unit, Department of Clinical, Surgical and Neuro-sciences, University of Siena, Italy
| | - Jean Luc Perrot
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Pietro Rubegni
- Dermatology Unit and Skin Bank Unit, Department of Clinical, Surgical and Neuro-sciences, University of Siena, Italy
| |
Collapse
|
18
|
Mazori DR, Kassamali B, Min MS, Schaefer M, LaChance AH, Sperling AS, Vleugels RA. Characteristics and Outcomes of Eosinophilic Fasciitis-Associated Monoclonal Gammopathy. JAMA Dermatol 2021; 157:1508-1509. [PMID: 34705045 DOI: 10.1001/jamadermatol.2021.4302] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Daniel R Mazori
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York
| | - Bina Kassamali
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Michelle S Min
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Department of Dermatology, University of California Irvine School of Medicine, Irvine
| | - Morgan Schaefer
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Avery H LaChance
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Adam S Sperling
- Harvard Medical School, Boston, Massachusetts.,Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts.,Division of Hematology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ruth Ann Vleugels
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
19
|
Gutierrez D, Peterson EL, Kim RH, Franks AG, Lo Sicco KI. Eosinophilic Fasciitis With Concomitant Morphea Profunda Treated With Intravenous Immunoglobulin. J Clin Rheumatol 2021; 27:S500-S501. [PMID: 31693648 DOI: 10.1097/rhu.0000000000001158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Daniel Gutierrez
- The Ronald O. Perelman Department of Dermatology New York University School of Medicine New York, NY
| | | | | | | | | |
Collapse
|
20
|
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
| |
Collapse
|
21
|
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.
Collapse
|
22
|
A case of eosinophilic fasciitis without skin manifestations: a case report in a patient with lupus and literature review. Clin Rheumatol 2020; 40:2477-2483. [PMID: 32974835 DOI: 10.1007/s10067-020-05416-6] [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] [Received: 06/16/2020] [Revised: 09/06/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Abstract
Eosinophilic fasciitis (EF) is a rare connective tissue disease that causes inflammation and fibrosis of the fascia, inducing pain and motor dysfunction. Characteristic skin manifestations, such as edema, erythema, induration, peau d'orange appearance, and the groove sign, are of diagnostic significance and observed in the majority of patients with EF. We herein report a case of EF without these characteristic skin manifestations. A 66-year-old Japanese woman developed progressive limb pain and motor dysfunction. No skin changes were observed. We diagnosed the patient with EF based on the clinical course, magnetic resonance imaging, and en bloc biopsy containing fascia and muscle. Oral prednisolone therapy markedly attenuated limb pain and motor dysfunctions. Through a systemic search of the medical literature, we retrieved 4 juvenile cases and 8 adult cases of EF without characteristic skin manifestations during the clinical course. We herein present a systemic review on EF without skin manifestations and discuss differences between the two proposed sets of diagnostic criteria of EF.
Collapse
|
23
|
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.
Collapse
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
| |
Collapse
|
24
|
Abstract
Eosinophilic dermatoses encompass a broad spectrum of diseases of different etiologies hallmarked by eosinophilic infiltration of the skin and/or mucous membranes, with or without associated blood eosinophilia. The wide range of dermatological manifestations of this spectrum, including nodules and plaques, pustules, blisters, ulcers, and urticarial lesions, is reflected in a non-univocal classification system. We identified six groups of eosinophilic dermatoses based on the predominant anatomic level of involvement: (1) epidermal; (2) of the dermal-epidermal junction; (3) dermal; (4) of the hypodermis and muscle fascia; (5) of the pilosebaceous unit; and (6) vascular/perivascular. We review clinicopathologic features and management of diseases belonging to each group, particularly: (1) pemphigus herpetiformis and atopic dermatitis as prototypes of the epidermal group; (2) bullous pemphigoid as prototypic eosinophilic dermatosis of the dermal-epidermal junction; (3) eosinophilic cellulitis (Wells syndrome), hypereosinophilic syndromes, Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome, eosinophilic dermatosis of hematologic malignancy and chronic spontaneous urticaria as paradigmatic dermal eosinophilic dermatoses; (4) eosinophilic fasciitis as an eosinophilic dermatosis with predominant involvement of the hypodermis and muscle fascia; (5) eosinophilic pustular folliculitis as a model of the pilosebaceous unit involvement; and (6) granuloma faciale, angiolymphoid hyperplasia with eosinophilia, and eosinophilic granulomatosis with polyangiitis, belonging to the vascular/perivascular group.
Collapse
|
25
|
Tkachenko E, Steuer AB, Lo K, LaChance A, Merola JF, Femia AN, Vleugels RA. Mycophenolate Mofetil for Eosinophilic Fasciitis: A Retrospective Analysis From 3 Tertiary Care Centers. JAMA Dermatol 2020; 156:595-597. [PMID: 32236487 DOI: 10.1001/jamadermatol.2020.0120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Elizabeth Tkachenko
- University of Massachusetts Medical School, Worcester, Massachusetts.,Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Alexa B Steuer
- The Ronald O. Perelman Department of Dermatology, New York University Langone Medical Center, New York
| | - Kelly Lo
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Avery LaChance
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Joseph F Merola
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Alisa N Femia
- The Ronald O. Perelman Department of Dermatology, New York University Langone Medical Center, New York
| | - Ruth Ann Vleugels
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| |
Collapse
|
26
|
Sturdy A, Stratton R, Perez-Machado M, Lamb L. Case of eosinophilic fasciitis during military training in a Nepalese British infantry soldier. BMJ Mil Health 2020; 166:277-278. [PMID: 32139410 DOI: 10.1136/jramc-2019-001273] [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] [Received: 07/02/2019] [Revised: 07/26/2019] [Accepted: 07/27/2019] [Indexed: 12/15/2022]
Abstract
We present the case of a Nepalese British soldier with peripheral oedema and a significantly raised eosinophil count. After extensive investigation looking for a parasitic cause of his illness, he was diagnosed with eosinophilic fasciitis, a connective tissue disorder, often triggered by heavy exertion and responsiveness to immunosuppression. In a military setting, in which clinicians are likely to encounter patients who have spent time in tropical areas, it is important to still consider non-infectious causes of eosinophilia.
Collapse
Affiliation(s)
- Ann Sturdy
- Department of Infection, Royal Free Hospital, London, UK
| | - R Stratton
- Department of Rheumatology, Royal Free Hospital, London, UK
| | - M Perez-Machado
- Department of Cellular Pathology, Royal Free Hospital, London, UK
| | - L Lamb
- Department of Infection, Royal Free Hospital, London, UK.,Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| |
Collapse
|
27
|
Prossor T, Sriskandarajah K, Vonberg FW, Dani M. Lessons of the month 2: Connecting the clues: limb swelling and pain. Clin Med (Lond) 2020; 20:105-106. [PMID: 31941742 DOI: 10.7861/clinmed.2019-0293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A 28-year-old man presented with a sudden onset of left leg pain and swelling. There was no history of preceding trauma. Initial blood tests were unremarkable, ultrasound imaging showed extensive subcutaneous oedema. He then developed similar symptoms in his right leg, followed by both arms, and finally his forehead. A fluctuating peripheral eosinophilia subsequently developed. Biopsies of the arm and forehead showed an evolving panniculitis. The clinical features, peripheral eosinophilia, imaging and histology were consistent with a diagnosis of eosinophilic fasciitis. The patient received a course of steroids with complete resolution of his symptoms. Eosinophilic fasciitis is an uncommon condition but one that may be encountered by acute physicians. Early recognition and treatment is important to prevent complications.
Collapse
Affiliation(s)
- Timothy Prossor
- London North West University Healthcare NHS Trust, London, UK
| | | | | | - Melanie Dani
- Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
28
|
Mango RL, Bugdayli K, Crowson CS, Drage LA, Wetter DA, Lehman JS, Peters MS, Davis MD, Chowdhary VR. Baseline characteristics and long-term outcomes of eosinophilic fasciitis in 89 patients seen at a single center over 20 years. Int J Rheum Dis 2019; 23:233-239. [PMID: 31811710 DOI: 10.1111/1756-185x.13770] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 10/20/2019] [Accepted: 11/20/2019] [Indexed: 11/27/2022]
Abstract
AIM Eosinophilic fasciitis (EF) is a rare, fibrosing disorder of skin and subcutaneous tissue. This study was undertaken to describe its clinical and laboratory features and identify prognostic factors associated with outcome. METHODS We conducted a retrospective review of all EF patients evaluated at our institution from 1 January1997 to 30 December 2016. Kaplan-Meier methods were used to determine treatment response rates over time. Potential associations between baseline characteristics and complete response were examined using Cox models adjusted for age and sex. Time-dependent covariates were used to examine treatment effects. RESULTS We identified 89 EF patients, with a female-to-male ratio of 1:1. Clinical features included groove sign in 26 (29%), peau d'orange/dimpling in 22 (25%), inflammatory arthritis in 9 (10%) and muscle weakness in 9 (10%). Aldolase was elevated in 11/36 (31%). Complete response rate was 60% (95% confidence interval [CI]: 35-75) at 3 years. Diagnostic delay was inversely associated with treatment response (hazards ratio: 0.84 per 1 month increase; 95% CI: 0.73-0.98). No baseline characteristics correlated with treatment response, but a trend toward positive association of elevated aldolase, hypergammaglobulinemia and presence of hematologic disorders was noted. Methotrexate was the most commonly used immunosuppressant in 79%, hydroxychloroquine in 45%, mycophenolate mofetil in 18% and azathioprine in 8%. No single immunosuppressant agent was associated with a superior response during treatment. CONCLUSIONS EF is characterized by relatively high response rates. Consensus diagnostic criteria, standardized management algorithms, and large prospective multi-center cohorts are needed to develop an evidence-directed approach to this challenging condition.
Collapse
Affiliation(s)
| | | | - Cynthia S Crowson
- Division of Rheumatology, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.,Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Lisa A Drage
- Department of Dermatology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - David A Wetter
- Department of Dermatology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Julia S Lehman
- Department of Dermatology, Mayo Clinic College of Medicine, Rochester, MN, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Margot S Peters
- Department of Dermatology, Mayo Clinic College of Medicine, Rochester, MN, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Mark D Davis
- Department of Dermatology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Vaidehi R Chowdhary
- Section of Rheumatology, Allergy and Immunology, Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
29
|
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.
Collapse
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.
| |
Collapse
|
30
|
Chan KK, Magro C, Shoushtari A, Rudin C, Rotemberg V, Rossi A, Lezcano C, Carrino J, Fernandez D, Postow MA, Apollo A, Lacouture ME, Bass AR. Eosinophilic Fasciitis Following Checkpoint Inhibitor Therapy: Four Cases and a Review of Literature. Oncologist 2019; 25:140-149. [PMID: 32043775 DOI: 10.1634/theoncologist.2019-0508] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 09/20/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Checkpoint inhibitor therapy is widely known to cause a number of immune-related adverse events. One rare adverse effect that is emerging is eosinophilic fasciitis, a fibrosing disorder causing inflammatory infiltration of subcutaneous fascia. It is characterized clinically by edema and subsequent induration and tightening of the skin and subcutaneous tissues. The condition is rare, yet at our institutions we have seen four cases in the past 3 years. We describe our 4 cases and review 11 other cases reported in the literature. CASE PRESENTATION We present four cases of eosinophilic fasciitis following treatment with programmed cell death protein 1 or programmed cell death-ligand 1 blockade. All patients had extremity involvement with characteristic skin changes ranging from peripheral edema to induration, tightening, and joint limitation. The patients had varying degrees of peripheral eosinophilia. In two of our patients, the diagnosis was made by full-thickness skin biopsy showing lymphocytic infiltration of the subcutaneous fascia, with CD4+ T cells predominating in one case and CD8+ T cells in the other. In the other two cases, the diagnosis was made on the basis of characteristic imaging findings in the context of clinical features consistent with the diagnosis. All four patients were treated with glucocorticoids with varying degrees of success; immunotherapy had to be discontinued in all four. Patients with advanced melanoma who experienced this adverse effect had either a partial response or a complete response to therapy. CONCLUSION Eosinophilic fasciitis can occur as a result of checkpoint inhibitor therapy. Although a tissue diagnosis is the gold standard, imaging studies may facilitate the diagnosis in the presence of consistent clinical features, but a degree of suspicion is key to recognizing the condition early. Therapy requires a collaborative approach by oncology, rheumatology, and dermatology; physical therapy is an important adjunct in treatment. For advanced melanoma, it may be a good prognostic indicator. IMPLICATIONS FOR PRACTICE It is important for clinicians to recognize that eosinophilic fasciitis is a potential immune-related adverse event (irAE) as a consequence of immune checkpoint inhibitor therapy. The presentation is quite stereotypical; the diagnosis can be made by imaging in the absence of a full-thickness skin biopsy. Early intervention is important to limit morbidity. This irAE may be a good prognostic sign among patients with melanoma.
Collapse
Affiliation(s)
- Karmela Kim Chan
- Department of Medicine, Hospital for Special Surgery, New York, New York, USA
| | - Cynthia Magro
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Alexander Shoushtari
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Charles Rudin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Veronica Rotemberg
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Anthony Rossi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Cecilia Lezcano
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - John Carrino
- Department of Radiology, Hospital for Special Surgery, New York, New York, USA
| | - David Fernandez
- Department of Medicine, Hospital for Special Surgery, New York, New York, USA
| | - Michael A Postow
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Arlyn Apollo
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mario E Lacouture
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Anne R Bass
- Department of Medicine, Hospital for Special Surgery, New York, New York, USA
| |
Collapse
|
31
|
Peckruhn M, Elsner P, Tittelbach J. Eosinophile Hautkrankheiten. J Dtsch Dermatol Ges 2019; 17:1039-1052. [DOI: 10.1111/ddg.13943_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/19/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Melanie Peckruhn
- Klinik für Hautkrankheiten, Universitätsklinikum Jena, Erklärung zu nichtfinanziellen Interesse: Organisation: Universitätsklinikum Jena Position in dieser Organisation: Fachärztin Mitgliedschaft und Position in wissenschaftlichen Gesellschaften/Berufsverbänden/Vereinigungen: keine
| | - Peter Elsner
- Klinik für Hautkrankheiten, Universitätsklinikum Jena, Erklärung zu nichtfinanziellen Interesse: Organisation: Universitätsklinikum Jena Position in dieser Organisation: Kliniksdirektor Mitgliedschaft und Position in wissenschaftlichen Gesellschaften/Berufsverbänden/Vereinigungen: Mitglied des Vorstands des BVDD, DDG Präsidium. Mitglied des Vorstands der DDG
| | - Jörg Tittelbach
- Klinik für Hautkrankheiten, Universitätsklinikum Jena Erklärung zu nichtfinanziellen Interesse: Organisation: Universitätsklinikum Jena Position in dieser Organisation: Oberarzt und stellv. Kliniksdirektor Mitgliedschaft und Position in wissenschaftlichen Gesellschaften/Berufsverbänden/Vereinigungen: Mitglied DDG
| |
Collapse
|
32
|
Peckruhn M, Elsner P, Tittelbach J. Eosinophilic dermatoses. J Dtsch Dermatol Ges 2019; 17:1039-1051. [DOI: 10.1111/ddg.13943] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/19/2019] [Indexed: 12/27/2022]
Affiliation(s)
| | - Peter Elsner
- Department of DermatologyUniversity Hospital Jena Germany
| | | |
Collapse
|
33
|
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.
Collapse
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
| | | |
Collapse
|
34
|
Liu Y, Zeng Y, Xie Y, Gao L, Chu H, Xiao Z, Lu Z. Eosinophilic fasciitis associated with myositis: Report of four cases and review of the literature. Australas J Dermatol 2018; 60:e227-e231. [PMID: 30592019 DOI: 10.1111/ajd.12973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 11/14/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Yin Liu
- Department of NeurologyRenmin Hospital of Wuhan University Wuhan Hubei Province China
| | - Yanping Zeng
- Department of NeurologyRenmin Hospital of Wuhan University Wuhan Hubei Province China
| | - Yanchun Xie
- Department of NeurologyRenmin Hospital of Wuhan University Wuhan Hubei Province China
| | - Likun Gao
- Department of Pathology Renmin Hospital of Wuhan University Wuhan Hubei Province China
| | - Hong Chu
- Department of NeurologyRenmin Hospital of Wuhan University Wuhan Hubei Province China
| | - Zheman Xiao
- Department of NeurologyRenmin Hospital of Wuhan University Wuhan Hubei Province China
| | - Zuneng Lu
- Department of NeurologyRenmin Hospital of Wuhan University Wuhan Hubei Province China
| |
Collapse
|
35
|
Batty T, Majeed S, Wlodek C, Gunawardena H. Unusual presentation of eosinophilic fasciitis (EF) with a raised ALT. BMJ Case Rep 2018; 11:11/1/e227369. [PMID: 30580305 DOI: 10.1136/bcr-2018-227369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Eosinophilic fasciitis (EF) is a syndrome of unknown aetiology characterised by progressive collagenous thickening of the subcutaneous fascia. Limb oedema can precede the skin thickening and induration classically associated with EF. We describe a case of EF in a 31-year-old woman who presented to her general practitioner with lower limb oedema and stiffness. Blood tests in primary care showed a persistently raised alanine transferase (ALT). No hepatic cause for her raised ALT was found despite investigation. The unusual manner of her presentation led to delay in her referral to the autoimmune connective tissue disease (CTD) clinic. This case illustrates the importance of considering autoimmune CTD such as EF in young patients presenting with limb oedema and raised ALT, as early treatment influences prognosis and functional recovery.
Collapse
Affiliation(s)
- Thomas Batty
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, UK
| | - Shuja Majeed
- Department of Rheumatology, North Bristol NHS Trust, Bristol, UK
| | - Christina Wlodek
- Department of Dermatology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | |
Collapse
|
36
|
Tull R, Hoover WD, De Luca JF, Huang WW, Jorizzo JL. Eosinophilic fasciitis: a case series with an emphasis on therapy and induction of remission. Drugs Context 2018; 7:212529. [PMID: 30302114 PMCID: PMC6172017 DOI: 10.7573/dic.212529] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 08/17/2018] [Accepted: 08/20/2018] [Indexed: 01/01/2023] Open
Abstract
Eosinophilic fasciitis is an uncommon connective tissue disorder that affects patients of all ages, resulting in significant morbidity. Systemic corticosteroids can induce remission of disease. However, there is no universally accepted treatment ladder for eosinophilic fasciitis. This case series evaluates treatment efficacy in patients with eosinophilic fasciitis seen at Wake Forest University Department of Dermatology outpatient clinics. Patient charts were screened using ICD-9 diagnosis code 710.9 (unspecified diffuse connective tissue disease) to identify patients with eosinophilic fasciitis (n=10) seen at our institution. Patients were treated for an average 24 months with a combination of methotrexate and prednisone therapy, unless one or both were contraindicated, with each medication tapered conservatively to prevent disease flares. Alternate treatments included mycophenolate mofetil with prednisone, azathioprine with prednisone, prednisone monotherapy, and methotrexate monotherapy. Disease remission off therapy and on low-dose therapy was 66 and 70%, respectively. Our first-line therapy of concomitant methotrexate and prednisone is well-tolerated and effective for managing patients with eosinophilic fasciitis. Our study was limited to cases seen at a single academic institution.
Collapse
Affiliation(s)
- Rechelle Tull
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - William D Hoover
- Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Jacqueline F De Luca
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - William W Huang
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Joseph L Jorizzo
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
37
|
Ferreli C, Gasparini G, Parodi A, Cozzani E, Rongioletti F, Atzori L. Cutaneous Manifestations of Scleroderma and Scleroderma-Like Disorders: a Comprehensive Review. Clin Rev Allergy Immunol 2018; 53:306-336. [PMID: 28712039 DOI: 10.1007/s12016-017-8625-4] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Scleroderma refers to an autoimmune connective tissue fibrosing disease, including three different subsets: localized scleroderma, limited cutaneous systemic sclerosis, and diffuse cutaneous systemic sclerosis with divergent patterns of organ involvement, autoantibody profiles, management, and prognostic implications. Although systemic sclerosis is considered the disease prototype that causes cutaneous sclerosis, there are many other conditions that can mimic and be confused with SSc. They can be classified into immune-mediated/inflammatory, immune-mediated/inflammatory with abnormal deposit (mucinoses), genetic, drug-induced and toxic, metabolic, panniculitis/vascular, and (para)neoplastic disorders according to clinico-pathological and pathogenetic correlations. This article reviews the clinical presentation with emphasis on cutaneous disease, etiopathogenesis, diagnosis, and treatment options available for the different forms of scleroderma firstly and for scleroderma-like disorders, including scleromyxedema, scleredema, nephrogenic systemic fibrosis, eosinophilic fasciitis, chronic graft-versus-host disease, porphyria cutanea tarda, diabetic stiff-hand syndrome (diabetic cheiroartropathy), and other minor forms. This latter group of conditions, termed also scleroderma mimics, sclerodermiform diseases, or pseudosclerodermas, shares the common thread of skin thickening but presents with distinct cutaneous manifestations, skin histology, and systemic implications or disease associations, differentiating each entity from the others and from scleroderma. The lack of Raynaud's phenomenon, capillaroscopic abnormalities, or scleroderma-specific autoantibodies is also important diagnostic clues. As cutaneous involvement is the earliest, most frequent and characteristic manifestation of scleroderma and sclerodermoid disorders, dermatologists are often the first-line doctors who must be able to promptly recognize skin symptoms to provide the affected patient a correct diagnosis and appropriate management.
Collapse
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
| |
Collapse
|
38
|
Kastsianok L, Ranganathan P. Skin Induration in a Patient With Aplastic Anemia. Arthritis Care Res (Hoboken) 2018; 70:1095-1100. [DOI: 10.1002/acr.23524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 01/23/2018] [Indexed: 11/10/2022]
Affiliation(s)
| | - Prabha Ranganathan
- Washington University School of Medicine in St. Louis; St. Louis Missouri
| |
Collapse
|
39
|
|
40
|
Pousa-Martínez M, Ginarte M, Suárez-Peñaranda JM, Vázquez-Veiga H. Skin ultrasound is a useful tool for evaluating and monitoring eosinophilic fasciitis. Int J Dermatol 2018; 57:743-745. [DOI: 10.1111/ijd.13986] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 01/18/2018] [Accepted: 03/05/2018] [Indexed: 11/29/2022]
Affiliation(s)
- María Pousa-Martínez
- Departament of Dermatology; University Hospital Complex of Santiago de Compostela; A Coruña Spain
| | - Manuel Ginarte
- Departament of Dermatology; University Hospital Complex of Santiago de Compostela; A Coruña Spain
| | | | - Hugo Vázquez-Veiga
- Departament of Dermatology; University Hospital Complex of Santiago de Compostela; A Coruña Spain
| |
Collapse
|
41
|
Chatterjee S, Prayson RA. Diffuse skin thickening, myalgias and joint stiffness in a 41-year-old man. CMAJ 2018; 190:E258-E261. [PMID: 29507157 DOI: 10.1503/cmaj.171012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Soumya Chatterjee
- Departments of Rheumatic and Immunologic Diseases (Chatterjee), and Anatomic Pathology (Prayson), Cleveland Clinic, Cleveland, OH
| | - Richard A Prayson
- Departments of Rheumatic and Immunologic Diseases (Chatterjee), and Anatomic Pathology (Prayson), Cleveland Clinic, Cleveland, OH
| |
Collapse
|
42
|
Moy AP, Maryamchik E, Nikolskaia OV, Nazarian RM. Th1- and Th17-polarized immune infiltrates in eosinophilic fasciitis-A potential marker for histopathologic distinction from morphea. J Cutan Pathol 2018; 44:548-552. [PMID: 28393380 DOI: 10.1111/cup.12947] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 04/05/2017] [Accepted: 04/06/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Morphea (localized scleroderma) and eosinophilic fasciitis (EF) are rare fibrosing disorders which may present a diagnostic challenge. While histopathologic features are often distinct, in some cases there may be overlap. T-cells contribute to etiopathogenesis of both autoimmune conditions. We sought to determine whether T-cell immune polarization enables histopathologic distinction. MATERIALS & METHODS We retrospectively examined clinicopathologically confirmed cases of morphea (n = 12) and EF (n = 8) using immunohistochemistry for CD3, CD8, and dual staining for CD4 with T-bet, GATA-3, STAT-3 or BNC-2 (transcription factors reported to be specific and mutually exclusive for Th1, Th2, Th17 and Th22 cells, respectively) to characterize the T-cell infiltrate. RESULTS No significant difference in CD3+ cells was identified (P = .195), however, the CD4/CD8+ T-cell ratio was significantly greater in morphea compared to EF (1.2 and 0.6, respectively; P = .034). Th1/Th2 was significantly lower in morphea compared to EF (1.7 and 2.7, respectively; P = .027). The percent of Th17+ cells was significantly higher in EF (P = 0.041). No significant difference in percent of Th22+ cells was identified. CONCLUSION Morphea and EF may be histopathologically distinguished based on helper T-cell subtype polarization. These findings offer novel insight into our understanding of disease pathogenesis and support a role for Th1/Th2 immune regulation and Th17 inhibition in anti-fibrotic therapeutic strategy.
Collapse
Affiliation(s)
- Andrea Primiani Moy
- Pathology Service, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Elena Maryamchik
- Pathology Service, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Olga V Nikolskaia
- Pathology Service, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Rosalynn M Nazarian
- Pathology Service, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
43
|
Wlodek C, Korendowych E, McHugh N, Lovell CR. Morphoea profunda and its relationship to eosinophilic fasciitis. Clin Exp Dermatol 2017; 43:306-310. [PMID: 29277925 DOI: 10.1111/ced.13353] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2017] [Indexed: 11/29/2022]
Abstract
In this small case series, all eight patients were women in their fifth and sixth decades. This is similar to the female predominance in morphoea and less in keeping with eosinophilic fasciitis (EF). All cases had diffuse induration of their limbs with both proximal and distal patterns of distribution, and five of the patients exhibited peau d'orange skin. All patients had diffuse induration of the lower limbs and half had restricted ankle movements. Six patients had concomitant superficial morphoea. This group of patients demonstrated a unique subtype of the morphoea spectrum with some features overlapping with EF. However, there appear to be points of distinction, and we propose that some previously reported cases labelled as EF would be better described as having morphoea profunda (MP). Methotrexate may be a useful treatment for MP, hence it is important to distinguish this from EF, as management may differ.
Collapse
Affiliation(s)
- C Wlodek
- Royal United Hospital Bath, Bath, Avon, UK
| | - E Korendowych
- Royal National Hospital for Rheumatic Diseases, Bath, Avon, UK
| | - N McHugh
- Royal National Hospital for Rheumatic Diseases, Bath, Avon, UK
| | - C R Lovell
- Royal United Hospital Bath, Bath, Avon, UK
| |
Collapse
|
44
|
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.
Collapse
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.
| |
Collapse
|
45
|
Fasciite à éosinophiles : caractéristiques cliniques, histologiques, thérapeutiques et pronostiques à partir d’une série de 51 cas. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.10.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
46
|
|
47
|
Abstract
Morphea, also known as localized scleroderma, encompasses a group of idiopathic sclerotic skin diseases. The spectrum ranges from relatively mild phenotypes, which generally cause few problems besides local discomfort and visible disfigurement, to subtypes with severe complications such as joint contractures and limb length discrepancies. Eosinophilic fasciitis (EF, Shulman syndrome) is often regarded as belonging to the severe end of the morphea spectrum. The exact driving mechanisms behind morphea and EF pathogenesis remain to be elucidated. However, extensive extracellular matrix formation and autoimmune dysfunction are thought to be key pathogenic processes. Likewise, these processes are considered essential in systemic sclerosis (SSc) pathogenesis. In addition, similarities in clinical presentation between morphea and SSc have led to many theories about their relatedness. Importantly, morphea may be differentiated from SSc based on absence of sclerodactyly, Raynaud’s phenomenon, and nailfold capillary changes. The diagnosis of morphea is often based on characteristic clinical findings. Histopathological evaluation of skin biopsies and laboratory tests are not necessary in the majority of morphea cases. However, full-thickness skin biopsies, containing fascia and muscle tissue, are required for the diagnosis of EF. Monitoring of disease activity and damage, especially of subcutaneous involvement, is one of the most challenging aspects of morphea care. Therefore, data harmonization is crucial for optimizing standard care and for comparability of study results. Recently, the localized scleroderma cutaneous assessment tool (LoSCAT) has been developed and validated for morphea. The LoSCAT is currently the most widely reported outcome measure for morphea. Care providers should take disease subtype, degree of activity, depth of involvement, and quality-of-life impairments into account when initiating treatment. In most patients with circumscribed superficial subtypes, treatment with topical therapies suffices. In more widespread disease, UVA1 phototherapy or systemic treatment with methotrexate (MTX), with or without a systemic corticosteroid combination, should be initiated. Disappointingly, few alternatives for MTX have been described and additional research is still needed to optimize treatment for these debilitating conditions. In this review, we present a state-of-the-art flow chart that guides care providers in the treatment of morphea and EF.
Collapse
|
48
|
Mertens JS, Thurlings RM, Kievit W, Seyger MMB, Radstake TRD, de Jong EMGJ. Long-term outcome of eosinophilic fasciitis: A cross-sectional evaluation of 35 patients. J Am Acad Dermatol 2017; 77:512-517.e5. [PMID: 28734566 DOI: 10.1016/j.jaad.2017.05.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/12/2017] [Accepted: 05/15/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Eosinophilic fasciitis (EF) is a connective tissue disease with an unknown long-term course. OBJECTIVE To evaluate presence and determinants of residual disease damage in patients with EF after long-term follow-up. METHODS Patients with biopsy-proven EF were included for this cross-sectional study. Outcome measures included the Physician's Global Assessment of Disease Activity, Physician's Global Assessment of Damage (PhysGA-D), skin pliability scores, passive range of motion, and health-related quality of Life (HRQoL) questionnaires. RESULTS In total, 35 patients (24 of whom were female [68.6%]) with a median age of 60 years participated. All patients had detectable residual damage. Impairment of HRQoL, assessed by the Dermatology Quality of Life Index and the 36-Item Short-Form Survey, correlated to the extent of residual damage. The PhysGA-D score at participation correlated to signs of severe disease at presentation, such as increased C-reactive protein level (Spearman's rho [rs ] = 0.486, P = .006), involvement of the neck (rs = 0.528, P = .001) and trunk (rs = 0.483, P = .003), prolonged time to disease remission (rs = 0.575, P = .003), and presence of concomitant morphea (rs = 0.349, P = .040). Lastly, maximum methotrexate dose correlated negatively to PhysGA-D score at study participation (rs = -0.393, P = .022). LIMITATIONS Sample size. CONCLUSION All patients with EF had detectable residual damage. Impairment of HRQoL correlated to the extent of residual damage. Advanced age and signs of severe disease at presentation were associated with the severity of residual damage.
Collapse
Affiliation(s)
- Jorre S Mertens
- Department of Dermatology, Radboud University, Nijmegen, The Netherlands; Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands; Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Rogier M Thurlings
- Department of Rheumatology, Radboud University, Nijmegen, The Netherlands
| | - Wietske Kievit
- Department of Epidemiology and Health Evidence, Radboud University, Nijmegen, The Netherlands
| | - Marieke M B Seyger
- Department of Dermatology, Radboud University, Nijmegen, The Netherlands
| | - Timothy R D Radstake
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands; Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Elke M G J de Jong
- Department of Dermatology, Radboud University, Nijmegen, The Netherlands; Radboud University Medical Centre, Radboud University, Nijmegen, The Netherlands
| |
Collapse
|
49
|
|
50
|
Maranda EL, Sheinin R, Brys A, Rubin B, Lim HW. A case of eosinophilic fasciitis associated with pyoderma gangrenosum. J Eur Acad Dermatol Venereol 2017; 31:e356-e358. [PMID: 28150344 DOI: 10.1111/jdv.14148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- E L Maranda
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - R Sheinin
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, 48202, USA
| | - A Brys
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, 48202, USA
| | - B Rubin
- Division of Rheumatology, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, 48202, USA
| | - H W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, 48202, USA
| |
Collapse
|