1
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Sami H, Sami F, Sami SA, Nashwan AJ. A Severe Case of Overlap of Morphea and Eosinophilic Fasciitis after Burn Injuries. Case Rep Rheumatol 2024; 2024:3123953. [PMID: 38774817 PMCID: PMC11108696 DOI: 10.1155/2024/3123953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 04/25/2024] [Accepted: 05/07/2024] [Indexed: 05/24/2024] Open
Abstract
Background Generalized morphea is a rare fibrosing skin illness that progresses from erythematous, violet-colored skin patches to sclerotic plaques. Another uncommon immune-mediated connective tissue disease called eosinophilic fasciitis (EF) evolves to cause sclerosis and woody skin induration. The coexistence of the two is extremely rare and has a poorer prognosis. Our case report is one of the first to report burn injuries as a trigger factor for EF and generalized morphea overlap. Case Presentation. A 36-year-old man presented with acute onset of rapidly progressing skin thickening, tender edema, and skin contractures involving all extremities, shortly after enduring burn injuries from a gasoline explosion. Workup was remarkable for peripheral eosinophilia, hypergammaglobulinemia, and elevated C-reactive protein. Skin biopsy demonstrated sclerodermoid changes and sclerotic thickening of subcutaneous fibrous septa associated with stromal mucin, dermal perivascular, diffuse lymphoplasmacytic infiltrate with eosinophils, decreased CD34 expression, and increased factor XIIIa. He was subsequently diagnosed with an overlap of generalized morphea and eosinophilic fasciitis. The patient had only limited improvement with steroids, methotrexate, mycophenolate mofetil, and intralesional triamcinolone acetonide injections. Conclusion Generalized morphea with concomitant EF indicates some degree of therapeutic resistance and poor prognosis with a low quality of life. Burn injuries can be a trigger factor for this overlap syndrome. Prompt identification of at-risk individuals and initiating aggressive management are necessary.
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Affiliation(s)
- Hania Sami
- Shalamar Medical and Dental College, Lahore, Pakistan
| | - Faria Sami
- Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL, USA
| | - Shahzad Ahmed Sami
- Internal Medicine, Trinity Health Oakland Campus, Pontiac, Michigan, USA
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2
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Mihailescu M, Abbas M. A difficult diagnosis of eosinophilic fasciitis: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241231384. [PMID: 38665934 PMCID: PMC11044792 DOI: 10.1177/2050313x241231384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/11/2023] [Indexed: 04/28/2024] Open
Abstract
Eosinophilic fasciitis can be a debilitating diagnosis and is often delayed given its similarities to other sclerotic conditions including morphea, such as bound-down indurated skin and inflammation and sclerotic thickening of tissue layers on histopathology. Delaying treatment can lead to joint contracture and residual hardness in skin which has both cosmetic and functional implications. Therefore, finding the definitive diagnosis and differentiating from other sclerotic diseases is important early in the disease course. We present a case of a 77-year-old female with a generalized rash on her back and extremities, and progressive symptoms of pain, joint contractures, and limited movement, which highlights the challenges in diagnosis and management given clinical and histological parallels between eosinophilic fasciitis and morphea.
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Affiliation(s)
- Mara Mihailescu
- University of Calgary, Cumming School of Medicine, Alberta, Canada
| | - Mariam Abbas
- University of Saskatchewan College of Medicine, Department of Medicine, Division of Dermatology, Saskatchewan, Canada
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3
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Fevrier A, Dufour PA. Eosinophilic Fasciitis Illustrated by 18 F-FDG PET/CT. Clin Nucl Med 2024; 49:e188-e190. [PMID: 38377376 DOI: 10.1097/rlu.0000000000005094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
ABSTRACT Eosinophilic fasciitis is a rare sclerodermiform disease characterized by upper and lower limb edema. We present the case of a 71-year-old woman currently hospitalized for painful lower limb edema. Laboratory tests reveal moderate eosinophilia (0.8 g/L) and an inflammatory syndrome. Abdominopelvic ultrasound reveals no abnormalities. In light of the unexplained inflammatory syndrome, a 18 F-FDG PET/CT scan currently shows intense hypermetabolism of the fasciae in the lower and upper limbs. Following an MRI, a biopsy is performed, and the anatomopathology currently confirms eosinophilic fasciitis.
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Affiliation(s)
- Agathe Fevrier
- From the Nuclear Medicine, University Hospital of Angers
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4
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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.
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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.
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5
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Li Y, Kong HE, Cheeley J. Eosinophilic fasciitis following COVID-19: A case series of 3 patients. JAAD Case Rep 2024; 44:6-10. [PMID: 38292575 PMCID: PMC10824685 DOI: 10.1016/j.jdcr.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Affiliation(s)
- Yiwen Li
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Ha Eun Kong
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Justin Cheeley
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
- Department of General Internal Medicine, Emory University School of Medicine, Atlanta, Georgia
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6
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Chittipolu S, Kennard JL, Nahar L. Eosinophilic Fasciitis in a 68-Year-Old Female. Cureus 2024; 16:e53908. [PMID: 38465140 PMCID: PMC10924695 DOI: 10.7759/cureus.53908] [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: 02/08/2024] [Indexed: 03/12/2024] Open
Abstract
Eosinophilic fasciitis (EF) is an uncommon disorder of unknown etiology and poorly understood pathogenesis. In this report, we present a case of a 68-year-old female presented with a rapidly progressing skin tightening condition in her extremities associated with eosinophilia. Four months prior, the patient's initial complaint was skin sensitivity in the legs and forearms. Over time, this led to severe skin tightening, edema, and decreased range of motion. Clinical examination showed tightening of the skin over the anterior forearms, posterior knees, and calves without sclerodactyly or Raynaud's phenomenon. Laboratory investigations showed eosinophilia, elevated antinuclear antibody titer, and negative rheumatoid factor. This presentation raised suspicion of EF, and biopsy results showed scattered lymphocytic infiltrate involving associated fibrous tissue and perivascular lymphocytic inflammation that involved vessel walls. She was treated with low-dose steroids due to her diabetes but the stiffness continued. She was started with immunomodulators methotrexate, which showed improvement in symptoms, including softening in her arm tissues.
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Affiliation(s)
| | | | - Ludmila Nahar
- Internal Medicine, North Mississippi Health Services, Tupelo, USA
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7
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Li Z, Li T, Li Z, Wang L, Long X, Huang J. Global research status of localised scleroderma reported over the period 1993-2022: A 30-year bibliometric analysis. Int Wound J 2024; 21:e14559. [PMID: 38272806 PMCID: PMC10805536 DOI: 10.1111/iwj.14559] [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: 10/19/2023] [Revised: 11/28/2023] [Accepted: 12/01/2023] [Indexed: 01/27/2024] Open
Abstract
Localised scleroderma predominantly affects the skin with an unknown aetiology. Despite its clinical importance, no comprehensive bibliometric analysis has been conducted to assess the existing research landscape and future prospects for localised scleroderma. The articles related to localised scleroderma were retrieved from the WoSCC database and analysed by VOSviewer 1.6.10.0 (Leiden University, Netherlands), CiteSpace 6.1.R1 (Dreiser University, USA), and HistCite 2.1 (New York, United States). 2049 research papers pertaining to localised scleroderma spanning the years from 1993 to 2022 were extracted from the WoSCC database. The United States exhibited the highest productivity with 644 papers, accounting for 31.43% of the total output, followed by Germany with 206 papers (10.05%) and Italy with 200 papers (9.76%). Regarding academic institutions and journals, the University of Texas System and Dermatology published the most significant number of papers, and Professor Ihn, H emerged as the most prolific contributor among scholars. The top 10 cited references primarily concentrated on the diagnosis and treatment of localised scleroderma. "Phototherapy" and "methotrexate (MTX)" surfaced as the most recent and noteworthy keywords, representing the research hotspots in the domain of localised scleroderma. This bibliometric analysis furnishes valuable insights into the contemporary research landscape of localised scleroderma.
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Affiliation(s)
- Zi‐Ming Li
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Tian‐Hao Li
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Zhu‐Jun Li
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Li‐Quan Wang
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Xiao Long
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Jiu‐Zuo Huang
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
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8
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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: 0] [Impact Index Per Article: 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.
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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
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9
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Khaleel M, Ayyad M, Khalil NCN, Tarayrah O, Tumezeh M, Bannoura S. Eosinophilic Fasciitis Presenting as Chronic Nonspecific Symptoms in a Young Adult. Oxf Med Case Reports 2023; 2023:omad131. [PMID: 38145270 PMCID: PMC10735454 DOI: 10.1093/omcr/omad131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/03/2023] [Accepted: 10/16/2023] [Indexed: 12/26/2023] Open
Abstract
Eosinophilic fasciitis (EF) is a rare inflammatory disease affecting various connective tissues. It is characterized by induration of the skin as well as scleroderma-like manifestations that are progressive and bilaterally symmetrical. Additionally, the joints and muscles are commonly involved, and rarely, there can be involvement of internal organs. The diagnosis of EF is based on clinical, laboratory, radiological, and a full-thickness skin biopsy involving the fascia. The biopsy is often diagnostic and shows eosinophilic inflammation. Systemic corticosteroids specifically prednisone and prednisolone remain the preferred treatment of choice and may be combined with immunosuppressive therapy in a subset of patients. We herein report a patient complaining of chronic nonspecific symptoms that were diagnosed with EF. The patient was treated with steroids with marked improvement of his overall condition.
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Affiliation(s)
- Mansour Khaleel
- Department of Internal Medicine, Makassed Hospital, Jerusalem, IL
| | - Mohammed Ayyad
- Internal Medicine Department, Al Quds University, Abu Dis, State of Palestine
| | - Nabil C N Khalil
- Department of Internal Medicine, Makassed Hospital, Jerusalem, IL
| | - Omar Tarayrah
- Department of Internal Medicine, Makassed Hospital, Jerusalem, IL
| | - Muath Tumezeh
- Department of Internal Medicine, Makassed Hospital, Jerusalem, IL
| | - Sami Bannoura
- Department of Pathology, Makassed Hospital, Jerusalem, IL
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10
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Popova V, Botushanov A, Batalov Z, Karalilova R, Batalov A. High-resolution musculoskeletal ultrasonography and elastography for eosinophilic fasciitis diagnosis and follow-up: a case-based review. Rheumatol Int 2023; 43:2311-2318. [PMID: 37747563 DOI: 10.1007/s00296-023-05401-7] [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: 05/27/2023] [Accepted: 07/19/2023] [Indexed: 09/26/2023]
Abstract
Eosinophilic fasciitis (EF) remains a rare condition without precise diagnostic criteria due to common symptoms with other autoimmune diseases requiring broad differential diagnosis. This paper describes the use of high-resolution musculoskeletal ultrasonography and elastography in the diagnosis and follow-up of eosinophilic fasciitis through the case of a 56-year-old male patient. In addition to laboratory data, instrumental data, and biopsy, musculoskeletal ultrasonography (US) was used both in the diagnostic process and in the follow-up period for an objective assessment of the changes in the patient's condition and response to treatment. The US showed disorganization of the myofibrils adjacent to the superficial fascia, edema, and thickening of the fascia and subcutaneous edema. In addition, the use of shear-wave elastography (SWE) demonstrated significantly reduced skin elasticity. High-frequency musculoskeletal ultrasound in combination with SWE is an effective method both for the diagnosis of EF and for the follow-up of the changes occurring after therapy. Based on the fact that it can easily differentiate the substrate of involvement, such as skin, subcutaneous tissue, or muscle fascia, ultrasound can be used to distinguish EF from other skin and muscle diseases.
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Affiliation(s)
- Velichka Popova
- Department of Rheumatology, Medical University of Plovdiv, Plovdiv, Bulgaria.
| | - Aleksandar Botushanov
- Department of Propaedeutics of Internal Diseases, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Zguro Batalov
- Department of Rheumatology, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Rositsa Karalilova
- Department of Rheumatology, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Anastas Batalov
- Department of Rheumatology, Medical University of Plovdiv, Plovdiv, Bulgaria
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11
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Woodbury MJ, Gaffney RG, Merola JF. A case of paradoxical eosinophilic fasciitis in a patient on benralizumab. JAAD Case Rep 2023; 40:45-46. [PMID: 37701884 PMCID: PMC10493231 DOI: 10.1016/j.jdcr.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Affiliation(s)
- Michael J. Woodbury
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rebecca G. Gaffney
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joseph F. Merola
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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12
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Caro-Chang LA, Fung MA. The role of eosinophils in the differential diagnosis of inflammatory skin diseases. Hum Pathol 2023; 140:101-128. [PMID: 37003367 DOI: 10.1016/j.humpath.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023]
Abstract
Eosinophils are known to be present in inflammatory skin diseases, but their diagnostic utility is not well established. Upon review of the published status of lesional eosinophils, several categories were identified. 1) Lesional eosinophils highly characteristic such that, in their absence, the pathologist may question the diagnosis. These include arthropod bite reactions and scabies, urticarial dermatitis, and other eosinophilic dermatoses. 2) Lesional eosinophils rare or absent, such that, in their presence, the pathologist may question the diagnosis. These include pityriasis lichenoides, graft versus host disease, and connective tissue disorders. 3) Lesional eosinophils variable and, while in some cases expected, are not required for diagnosis. These include drug reactions, atopic dermatitis and allergic contact dermatitis. 4) Lesional eosinophils variable and not expected but may be seen to a limited extent. These include lichen planus and psoriasis.
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13
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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.
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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
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14
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Bobeica C, Niculet E, Craescu M, Parapiru EL, Corduneanu-Luca AM, Debita M, Pelin AM, Tiutiuca C, Vasile CI, Nicolescu AC, Miulescu M, Balan G, Tatu AL. Immunologic and nonimmunologic sclerodermal skin conditions - review. Front Immunol 2023; 14:1180221. [PMID: 37600771 PMCID: PMC10432860 DOI: 10.3389/fimmu.2023.1180221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/16/2023] [Indexed: 08/22/2023] Open
Abstract
Scleroderma-like cutaneous lesions have been found in many pathological conditions and they have the clinical appearance of sclerotic or scleroatrophic lesions. Affected skin biopsies described histopathological changes similar to those of scleroderma located strictly on the skin or those of systemic sclerosis. These skin lesions can be found in inflammatory diseases with autoimmune substrate (generalized morphea, chronic graft versus host disease, eosinophilic fasciitis), tissue storage diseases (scleredema, scleromyxedema, nephrogenyc systemic fibrosis, systemic amyloidosis), metabolic diseases (porphyrya cutanea tarda, phenylketonuria, hypothyroidism, scleredema diabeticorum), progeroid syndromes. Given the multiple etiologies of sclerodermal lesions, a correct differential diagnosis is necessary to establish the appropriate treatment.
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Affiliation(s)
- Carmen Bobeica
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
| | - Elena Niculet
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR (Centrul Integrat Multidisciplinar de Cercetare de Interfata Dermatologica - CIM-CID), “Dunărea de Jos” University, Galaţi, Romania
| | - Mihaela Craescu
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR (Centrul Integrat Multidisciplinar de Cercetare de Interfata Dermatologica - CIM-CID), “Dunărea de Jos” University, Galaţi, Romania
| | - Elena-Laura Parapiru
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
| | | | - Mihaela Debita
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
| | - Ana Maria Pelin
- Department of Pharmaceutical Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
| | - Carmen Tiutiuca
- Clinical Surgical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
| | - Claudiu Ionut Vasile
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
| | - Alin Codrut Nicolescu
- Dermatology Department “Agrippa Ionescu” Emergency Clinical Hospital, Bucharest, Romania
| | - Magdalena Miulescu
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
| | - Gabriela Balan
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
- Research Center in the Field of Medical and Pharmaceutical Sciences, “Dunărea de Jos” University, Galaţi, Romania
| | - Alin Laurentiu Tatu
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR (Centrul Integrat Multidisciplinar de Cercetare de Interfata Dermatologica - CIM-CID), “Dunărea de Jos” University, Galaţi, Romania
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
- Dermatology Department, “Sf. Cuvioasa Parascheva” Clinical Hospital of Infectious Diseases, Galaţi, Romania
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15
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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.
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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
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16
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Mazilu D, Boltașiu (Tătaru) LA, Mardale DA, Bijă MS, Ismail S, Zanfir V, Negoi F, Balanescu AR. Eosinophilic Fasciitis: Current and Remaining Challenges. Int J Mol Sci 2023; 24:ijms24031982. [PMID: 36768300 PMCID: PMC9916848 DOI: 10.3390/ijms24031982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/09/2023] [Accepted: 01/14/2023] [Indexed: 01/20/2023] Open
Abstract
Eosinophilic fasciitis (EF), defined as diffuse fasciitis with eosinophilia by Shulman in 1974, is a disease with unknown etiology and whose pathogenesis is still being researched. The diagnosis is based on the clinical aspects (skin induration with an "orange peel" appearance), the lab results (eosinophilia, increased inflammatory markers), the skin biopsy with the pathognomonic histopathological result, as well as the typical MRI changes. The treatment includes glucocorticoids and immunosuppressive drugs. Due to severe refractory cases, the treatment remains a challenge. EF is still a disease with potential for further research.
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Affiliation(s)
- Diana Mazilu
- “Sfanta Maria” Clinical Hospital, Ion Mihalache blvd, 37-39, 011172 Bucharest, Romania
- “Carol Davila” University of Medicine, Dionisie Lupu Street, nr 37, 020021 Bucharest, Romania
- Correspondence: (D.M.); (L.A.B.)
| | - Laura Alina Boltașiu (Tătaru)
- “Sfanta Maria” Clinical Hospital, Ion Mihalache blvd, 37-39, 011172 Bucharest, Romania
- Correspondence: (D.M.); (L.A.B.)
| | - Denise-Ani Mardale
- “Sfanta Maria” Clinical Hospital, Ion Mihalache blvd, 37-39, 011172 Bucharest, Romania
- “Carol Davila” University of Medicine, Dionisie Lupu Street, nr 37, 020021 Bucharest, Romania
| | - Maria Silviana Bijă
- “Sfanta Maria” Clinical Hospital, Ion Mihalache blvd, 37-39, 011172 Bucharest, Romania
| | - Sermina Ismail
- “Sfanta Maria” Clinical Hospital, Ion Mihalache blvd, 37-39, 011172 Bucharest, Romania
| | - Violeta Zanfir
- “Sfanta Maria” Clinical Hospital, Ion Mihalache blvd, 37-39, 011172 Bucharest, Romania
| | - Florentina Negoi
- “Sfanta Maria” Clinical Hospital, Ion Mihalache blvd, 37-39, 011172 Bucharest, Romania
| | - Andra Rodica Balanescu
- “Sfanta Maria” Clinical Hospital, Ion Mihalache blvd, 37-39, 011172 Bucharest, Romania
- “Carol Davila” University of Medicine, Dionisie Lupu Street, nr 37, 020021 Bucharest, Romania
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17
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LOPES AR, BRANCO LC, PEREIRA C, COELHO M, PINELO E. Shulman Syndrome: a clinical case, two rare associations. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2022. [DOI: 10.23736/s0393-3660.21.04622-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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18
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Samuels H, Malov M, Saha Detroja T, Ben Zaken K, Bloch N, Gal-Tanamy M, Avni O, Polis B, Samson AO. Autoimmune Disease Classification Based on PubMed Text Mining. J Clin Med 2022; 11:jcm11154345. [PMID: 35893435 PMCID: PMC9369164 DOI: 10.3390/jcm11154345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/15/2022] [Accepted: 07/08/2022] [Indexed: 11/30/2022] Open
Abstract
Autoimmune diseases (AIDs) are often co-associated, and about 25% of patients with one AID tend to develop other comorbid AIDs. Here, we employ the power of datamining to predict the comorbidity of AIDs based on their normalized co-citation in PubMed. First, we validate our technique in a test dataset using earlier-reported comorbidities of seven knowns AIDs. Notably, the prediction correlates well with comorbidity (R = 0.91) and validates our methodology. Then, we predict the association of 100 AIDs and classify them using principal component analysis. Our results are helpful in classifying AIDs into one of the following systems: (1) gastrointestinal, (2) neuronal, (3) eye, (4) cutaneous, (5) musculoskeletal, (6) kidneys and lungs, (7) cardiovascular, (8) hematopoietic, (9) endocrine, and (10) multiple. Our classification agrees with experimentally based taxonomy and ranks AID according to affected systems and gender. Some AIDs are unclassified and do not associate well with other AIDs. Interestingly, Alzheimer’s disease correlates well with other AIDs such as multiple sclerosis. Finally, our results generate a network classification of autoimmune diseases based on PubMed text mining and help map this medical universe. Our results are expected to assist healthcare workers in diagnosing comorbidity in patients with an autoimmune disease, and to help researchers in identifying common genetic, environmental, and autoimmune mechanisms.
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Affiliation(s)
- Hadas Samuels
- Azrieli Faculty of Medicine, Bar Ilan University, Safed 1311502, Israel; (H.S.); (M.M.); (T.S.D.); (K.B.Z.); (N.B.); (M.G.-T.); (O.A.)
| | - Malki Malov
- Azrieli Faculty of Medicine, Bar Ilan University, Safed 1311502, Israel; (H.S.); (M.M.); (T.S.D.); (K.B.Z.); (N.B.); (M.G.-T.); (O.A.)
| | - Trishna Saha Detroja
- Azrieli Faculty of Medicine, Bar Ilan University, Safed 1311502, Israel; (H.S.); (M.M.); (T.S.D.); (K.B.Z.); (N.B.); (M.G.-T.); (O.A.)
| | - Karin Ben Zaken
- Azrieli Faculty of Medicine, Bar Ilan University, Safed 1311502, Israel; (H.S.); (M.M.); (T.S.D.); (K.B.Z.); (N.B.); (M.G.-T.); (O.A.)
| | - Naamah Bloch
- Azrieli Faculty of Medicine, Bar Ilan University, Safed 1311502, Israel; (H.S.); (M.M.); (T.S.D.); (K.B.Z.); (N.B.); (M.G.-T.); (O.A.)
| | - Meital Gal-Tanamy
- Azrieli Faculty of Medicine, Bar Ilan University, Safed 1311502, Israel; (H.S.); (M.M.); (T.S.D.); (K.B.Z.); (N.B.); (M.G.-T.); (O.A.)
| | - Orly Avni
- Azrieli Faculty of Medicine, Bar Ilan University, Safed 1311502, Israel; (H.S.); (M.M.); (T.S.D.); (K.B.Z.); (N.B.); (M.G.-T.); (O.A.)
| | - Baruh Polis
- School of Medicine, Yale University, New Haven, CT 06520, USA;
| | - Abraham O. Samson
- Azrieli Faculty of Medicine, Bar Ilan University, Safed 1311502, Israel; (H.S.); (M.M.); (T.S.D.); (K.B.Z.); (N.B.); (M.G.-T.); (O.A.)
- Correspondence:
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19
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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: 0] [Impact Index Per Article: 0] [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.
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20
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MRI Findings of Eosinophilic Fasciitis. J Belg Soc Radiol 2022; 106:48. [PMID: 35651918 PMCID: PMC9138716 DOI: 10.5334/jbsr.2805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/01/2022] [Indexed: 11/20/2022] Open
Abstract
Teaching point: Eosinophilic fasciitis (EF) is a rare sclerodermiform disease characterized by upper- and lower-limbs oedema and hardness, which should be confirmed by skin biopsy and MRI in case of clinical suspicion.
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21
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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.
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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
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22
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Jabbouri R, Bouanani N, Aniq Filali R, Aasfara J. Eosinophilic Fasciitis and Smoldering Multiple Myeloma: An Exceptional Association in Young Adults. Cureus 2022; 14:e23896. [PMID: 35530826 PMCID: PMC9076050 DOI: 10.7759/cureus.23896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 12/03/2022] Open
Abstract
Eosinophilic fasciitis (EF) or Shulman's fasciitis is a rare condition characterized by subcutaneous edematous induration sparing the face and distal extremities and progressing to skin sclerosis. Its association with other pathologies, notably hemopathies, is described in the literature, but its association with smoldering multiple myeloma remains very rare, especially in a younger subject.
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23
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Su WQ, Fu YZ, Liu SY, Cao MJ, Xue YB, Suo FF, Liu WC. Eosinophilia complicated with venous thromboembolism: A case report. World J Clin Cases 2022; 10:1952-1960. [PMID: 35317148 PMCID: PMC8891765 DOI: 10.12998/wjcc.v10.i6.1952] [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: 08/28/2021] [Revised: 12/01/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Eosinophilia is an increase of more than 0.5 × 109/L in the number of eosinophils; it is a systemic condition with an unknown etiology and is often accompanied by multiple impaired organ functions. The clinical manifestations of the disease are highly variable and diverse, rendering identification of the diagnosis challenging; hence, diagnosis and treatment are often delayed. Very few reports of this disease exist globally, especially with rare manifestations of cerebral venous sinus thrombosis and hemorrhage.
CASE SUMMARY A 32-year-old woman with eosinophilia presented to the hospital with bilateral lower-limb edema as the first clinical manifestation, followed by an extensive maculopapular rash throughout the body. She subsequently developed cerebral venous sinus thrombosis along with bilateral lower-limb deep vein thrombosis. Two weeks earlier, she had received a single course of antibiotics from a local hospital for a low-grade fever and sore throat. After various treatments were administered for anticoagulation, maintaining blood circulation, and relieving blood stasis, the lower extremity edema improved significantly; however, the patient’s eosinophil count gradually increased. She experienced cerebral venous sinus thrombosis, cerebral hemorrhage, and deep vein thrombosis of the lower limbs before being declared brain dead. In this case report, we have elaborated the diagnosis and management of deep vein thrombosis manifested as eosinophilia, thrombocytopenia, and elevated D-dimer levels.
CONCLUSION Because proper diagnosis is challenging, clinical vigilance is required for patients with eosinophilia, as it can lead to thrombus formation.
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Affiliation(s)
- Wei-Qiang Su
- Department of Vascular Surgery, The Second People’s Hospital of Jiaozuo City, Jiaozuo 454000, Henan Province, China
| | - Yan-Zhong Fu
- Department of Vascular Surgery, The Second People’s Hospital of Jiaozuo City, Jiaozuo 454000, Henan Province, China
| | - Shu-Yan Liu
- Department of Endocrine, The Second People’s Hospital of Jiaozuo City, Jiaozuo 454000, Henan Province, China
| | - Meng-Jie Cao
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Ya-Bin Xue
- Department of Vascular Surgery, The Second People’s Hospital of Jiaozuo City, Jiaozuo 454000, Henan Province, China
| | - Fei-Fei Suo
- Department of Vascular Surgery, The Second People’s Hospital of Jiaozuo City, Jiaozuo 454000, Henan Province, China
| | - Wen-Chao Liu
- Clinical Laboratory, The Second People’s Hospital of Jiaozuo City, Jiaozuo 454000, Henan Province, China
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24
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Foti R, De Pasquale R, Dal Bosco Y, Visalli E, Amato G, Gangemi P, Foti R, Ramondetta A. Clinical and Histopathological Features of Scleroderma-like Disorders: An Update. Medicina (B Aires) 2021; 57:medicina57111275. [PMID: 34833493 PMCID: PMC8625286 DOI: 10.3390/medicina57111275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/10/2021] [Accepted: 11/18/2021] [Indexed: 11/25/2022] Open
Abstract
Scleroderma-like disorders include a set of entities involving cutis, subcutis and, sometimes, even muscular tissue, caused by several pathogenetic mechanisms responsible for different clinical–pathological pictures. The absence of antinuclear antibodies (ANA), Raynaud’s phenomenon and capillaroscopic anomalies constitutes an important element of differential diagnosis with systemic sclerosis. When scleroderma can be excluded, on the basis of the main body sites, clinical evolution, any associated pathological conditions and specific histological features, it is possible to make a correct diagnosis.
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Affiliation(s)
- Rosario Foti
- Division of Reumathology, A.O.U. “Policlinico-San Marco”, 95123 Catania, Italy; (R.F.); (Y.D.B.); (E.V.); (G.A.)
| | - Rocco De Pasquale
- U.O. Dermatologia, Ospedale San Marco, 95123 Catania, Italy; (R.D.P.); (R.F.)
| | - Ylenia Dal Bosco
- Division of Reumathology, A.O.U. “Policlinico-San Marco”, 95123 Catania, Italy; (R.F.); (Y.D.B.); (E.V.); (G.A.)
| | - Elisa Visalli
- Division of Reumathology, A.O.U. “Policlinico-San Marco”, 95123 Catania, Italy; (R.F.); (Y.D.B.); (E.V.); (G.A.)
| | - Giorgio Amato
- Division of Reumathology, A.O.U. “Policlinico-San Marco”, 95123 Catania, Italy; (R.F.); (Y.D.B.); (E.V.); (G.A.)
| | - Pietro Gangemi
- U.O. Anatomia Patologica, Ospedale San Marco, 95123 Catania, Italy;
| | - Riccardo Foti
- U.O. Dermatologia, Ospedale San Marco, 95123 Catania, Italy; (R.D.P.); (R.F.)
| | - Alice Ramondetta
- U.O. Dermatologia, Ospedale San Marco, 95123 Catania, Italy; (R.D.P.); (R.F.)
- Correspondence: ; Tel.: +39-095-479-4298
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25
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Ansari S, Iftikhar U, Jamil A, Ansari A, Iftikhar S. Eosinophilic Fasciitis With a Malignant Outcome. J Med Cases 2021; 12:220-222. [PMID: 34434461 PMCID: PMC8383512 DOI: 10.14740/jmc3665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/12/2021] [Indexed: 11/12/2022] Open
Abstract
Eosinophilic fasciitis (EF) is an uncommon localized fibrosing disorder affecting the fascial layers of the human body. To date less than 300 cases of EF have been reported worldwide. Due to the limited prevalence, extensive studying of its pathogenesis and treatment has not yet been established. Furthermore, little is known regarding the long-term prognosis and comorbidities associated with EF. In this case study, we discuss a 72-year-old female patient who was diagnosed with EF and subsequently developed squamous cell carcinoma (SCC) of the skin in areas of previously exposed EF. This case represents the first reported case of SCC of the skin in a patient with previously active EF in the same area of skin.
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Affiliation(s)
- Salman Ansari
- Department of Biochemistry, University of California, Santa Barbara, CA, USA
| | - Umair Iftikhar
- Department of Education, Carden Arbor View School, Upland, CA, USA
| | - Asma Jamil
- Department of Medicine, University of California, Riverside School of Medicine/Riverside Community Hospital, Riverside, CA, USA
| | - Aamir Ansari
- Department of Medicine, University of California, Riverside School of Medicine/Riverside Community Hospital, Riverside, CA, USA
| | - Syed Iftikhar
- Department of Medicine, University of California, Riverside School of Medicine/Riverside Community Hospital, Riverside, CA, USA
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26
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Furnishing Wound Repair by the Subcutaneous Fascia. Int J Mol Sci 2021; 22:ijms22169006. [PMID: 34445709 PMCID: PMC8396603 DOI: 10.3390/ijms22169006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/10/2021] [Accepted: 08/17/2021] [Indexed: 12/28/2022] Open
Abstract
Mammals rapidly heal wounds through fibrous connective tissue build up and tissue contraction. Recent findings from mouse attribute wound healing to physical mobilization of a fibroelastic connective tissue layer that resides beneath the skin, termed subcutaneous fascia or superficial fascia, into sites of injury. Fascial mobilization assembles diverse cell types and matrix components needed for rapid wound repair. These observations suggest that the factors directly affecting fascial mobility are responsible for chronic skin wounds and excessive skin scarring. In this review, we discuss the link between the fascia's unique tissue anatomy, composition, biomechanical, and rheologic properties to its ability to mobilize its tissue assemblage. Fascia is thus at the forefront of tissue pathology and a better understanding of how it is mobilized may crystallize our view of wound healing alterations during aging, diabetes, and fibrous disease and create novel therapeutic strategies for wound repair.
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27
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Newe M, Kant TA, Hoffmann M, Rausch JSE, Winter L, Künzel K, Klapproth E, Günther C, Künzel SR. Systemic mesalazine treatment prevents spontaneous skin fibrosis in PLK2-deficient mice. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2021; 394:2233-2244. [PMID: 34410453 PMCID: PMC8514377 DOI: 10.1007/s00210-021-02135-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/30/2021] [Indexed: 11/27/2022]
Abstract
Skin fibrosis is a complex biological remodeling process occurring in disease like systemic sclerosis, morphea, or eosinophilic fasciitis. Since the knowledge about the underlying pathomechanisms is still incomplete, there is currently no therapy, which prevents or reverses skin fibrosis sufficiently. The present study investigates the role of polo-like kinase 2 (PLK2) and the pro-fibrotic cytokine osteopontin (OPN) in the pathogenesis of cutaneous fibrosis and demonstrates the antifibrotic effects of systemic mesalazine treatment in vivo. Isolated primary dermal fibroblasts of PLK2 wild-type (WT) and knockout (KO) mice were characterized invitro. Skin thickness and histoarchitecture were studied in paraffin-embedded skin sections. The effects of mesalazine treatment were examined in isolated fibroblasts and PLK2 KO mice, which were fed 100 µg/g mesalazine for 6 months via the drinking water. Compared to WT, PLK2 KO fibroblasts displayed higher spontaneous myofibroblast differentiation, reduced proliferation rates, and overexpression of the fibrotic cytokine OPN. Invitro, 72 h of treatment with 10 mmol/L mesalazine induced phenotype conversion in PLK2 KO fibroblasts and attenuated OPN expression by inhibiting ERK1/2. In vivo, dermal myofibroblast differentiation, collagen accumulation, and skin thickening were prevented by mesalazine in PLK2 KO. Plasma creatinine levels indicated good tolerability of systemic long-term mesalazine treatment. The current study reveals a spontaneous fibrotic skin phenotype and ERK1/2-dependent OPN overexpression in PLK2 KO mice. We provide experimental evidence for the antifibrotic effectiveness of systemic mesalazine treatment to prevent fibrosis of the skin, suggesting further investigation in experimental and clinical settings.
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Affiliation(s)
- Manja Newe
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fiedlerstraße 42, 01309, Dresden, Germany
| | - Theresa A Kant
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fiedlerstraße 42, 01309, Dresden, Germany
| | - Maximilian Hoffmann
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fiedlerstraße 42, 01309, Dresden, Germany
| | - Johanna S E Rausch
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fiedlerstraße 42, 01309, Dresden, Germany
| | - Luise Winter
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fiedlerstraße 42, 01309, Dresden, Germany
| | - Karolina Künzel
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fiedlerstraße 42, 01309, Dresden, Germany
| | - Erik Klapproth
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fiedlerstraße 42, 01309, Dresden, Germany
| | - Claudia Günther
- Department of Dermatology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Stephan R Künzel
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fiedlerstraße 42, 01309, Dresden, Germany.
- Department of Dermatology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
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28
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Belmesk L, Muntyanu A, Cantin E, AlHalees Z, Jack CS, Le M, Sasseville D, Iannattone L, Ben-Shoshan M, Litvinov IV, Netchiporouk E. Prominent Role of Type 2 Immunity in Skin Diseases-Beyond Atopic Dermatitis. J Cutan Med Surg 2021; 26:33-49. [PMID: 34261335 DOI: 10.1177/12034754211027858] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Type 2 immunity, illustrated by T helper 2 lymphocytes (Th2) and downstream cytokines (IL-4, IL-13, IL-31) as well as group 2 innate lymphoid cells (ILC2), is important in host defense and wound healing.1 The hallmark of type 2 inflammation is eosinophilia and/or high IgE counts and is best recognized in atopic diathesis. Persistent eosinophilia, such as seen in hypereosinophilic syndromes, leads to fibrosis and hence therapeutic Type 2 inhibition in fibrotic diseases is of high interest. Furthermore, as demonstrated in cutaneous T cell lymphoma, advanced disease is characterized by Th1 to Th2 switch allowing cancer progression and immunosuppression. Development of targeted monoclonal antibodies against IL-4Rα (eg, dupilumab) led to a paradigm shift for the treatment of atopic dermatitis (AD) and stimulated research to better understand the role of Type 2 inflammation in other skin conditions. In this review, we summarize up to date knowledge on the role of Type 2 inflammation in skin diseases other than AD and highlight whether the use of Type 2 targeted therapies has been documented or is being investigated in clinical trials. This manuscript reviews the role of Type 2 inflammation in dermatitis, neurodermatitis, IgE-mediated dermatoses (eg, bullous pemphigoid, chronic spontaneous urticaria), sclerodermoid conditions and skin neoplasms.
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Affiliation(s)
| | - Anastasiya Muntyanu
- 544735620507266 Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | | | - Zeinah AlHalees
- 544735620507266 Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | - Carolyn S Jack
- 544735620507266 Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | - Michelle Le
- 544735620507266 Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | - Denis Sasseville
- 544735620507266 Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | - Lisa Iannattone
- 60301 Division of Dermatology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | - Moshe Ben-Shoshan
- Division of Pediatric Allergy Immunology and Dermatology, Department of Pediatrics, McGill University Health Center, Montreal, QC, Canada
| | - Ivan V Litvinov
- 544735620507266 Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | - Elena Netchiporouk
- 544735620507266 Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
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Radonjic-Hoesli S, Brüggen MC, Feldmeyer L, Simon HU, Simon D. Eosinophils in skin diseases. Semin Immunopathol 2021; 43:393-409. [PMID: 34097126 PMCID: PMC8241748 DOI: 10.1007/s00281-021-00868-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/06/2021] [Indexed: 02/06/2023]
Abstract
Eosinophil infiltration is a common finding in a broad spectrum of skin diseases, despite the fact that the skin is devoid of eosinophils under physiologic conditions. Although cutaneous eosinophilia is reactive, cytokine-mediated in most cases, diseases with an intrinsic mutation-mediated clonal expansion of eosinophils can also manifest on the skin. As eosinophils are involved in host defense, regulate immune responses, generate pruritus, induce remodeling and fibrosis, and can cause tissue damage, they have the capacity to actively contribute to the pathogenesis of diseases. Recent research provided deeper insights in the mechanisms, e.g., bacterial and viral clearance, blister formation, recruitment of cytotoxic T cells, and generation of pruritus, by which eosinophils might come into action. This review aims at providing an overview on the clinical presentations of eosinophil-associated dermatoses and the current understanding of their pathogenic role in these diseases. Further, we discuss the effects of therapies targeting eosinophils.
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Affiliation(s)
- Susanne Radonjic-Hoesli
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marie-Charlotte Brüggen
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Department of Dermatology, Hochgebirgsklinik Davos, Davos, Switzerland
| | - Laurence Feldmeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hans-Uwe Simon
- Institute of Pharmacology, University of Bern, Bern, Switzerland
- Department of Clinical Immunology and Allergology, Sechenov University, Moscow, Russia
- Laboratory of Molecular Immunology, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Dagmar Simon
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Śmigielska P, Czarny J, Kowalski J, Wilkowska A, Nowicki RJ. Refractory eosinophilic fasciitis successfully treated with infliximab: A case report. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2021; 6:211-213. [DOI: 10.1177/23971983211004399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 02/23/2021] [Indexed: 11/16/2022]
Abstract
Eosinophilic fasciitis is a rare connective tissue disease of unknown etiology. Therapeutic options include high-dose corticosteroids and other immunosuppressive drugs. We present a typical eosinophilic fasciitis case, which did not respond to first-line treatment, but improved remarkably after infliximab administration. This report demonstrates that in case of initial treatment failure, infliximab might be a relatively safe and effective way of eosinophilic fasciitis management.
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Affiliation(s)
- Paulina Śmigielska
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, Gdańsk, Poland
| | - Justyna Czarny
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, Gdańsk, Poland
| | - Jacek Kowalski
- Department of Pathomorphology, Medical University of Gdańsk, Gdańsk, Poland
| | - Aleksandra Wilkowska
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, Gdańsk, Poland
| | - Roman J. Nowicki
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, Gdańsk, Poland
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Eosinophilic fasciitis in a pregnant woman with corticosteroid dependence and good response to infliximab. Rheumatol Int 2021; 41:1531-1539. [PMID: 33484332 DOI: 10.1007/s00296-021-04787-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Abstract
Eosinophilic fasciitis (EF) is characterized by symmetrical thickening of subcutaneous muscular fascia, causing skin induration with wrinkles and prominent hair follicles: the classic peau d'orange. Eosinophilia is a characteristic-albeit not universal-finding. We present the case of a 43-year-old pregnant woman diagnosed with EF during pregnancy who had extensive cutaneous involvement and severe functional repercussions, including worsening of lung function and intrauterine growth restriction as a possible complication. Treatment with prednisone was initiated during gestation and it was necessary to increase the dose. After delivery, methotrexate treatment was initiated and the corticosteroid dose progressively decreased, with progressive worsening in the torso and abdomen and secondary dyspnea due to thoracic pressure. Treatment with infliximab was then initiated, with favorable progress, though residual ankle and tarsal joint stiffness and significant muscular atrophy in the limbs continued. The triggering factor of EF was not identified. In a systematic search of the medical literature, three cases of EF in pregnant woman without clear triggers were found. Interestingly, all three cases progressed favorably with steroid treatment. Apart from this case, there are only seven published cases of infliximab use in the literature, all with moderate or complete response. Infliximab could be an option for corticosteroid-dependent EF with no response to other options.
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Pabón-Cartagena G, López A, Watts E, Alonso N. Eosinophilic fasciitis in association with nivolumab: The importance of eosinophilia. JAAD Case Rep 2020; 6:1303-1306. [PMID: 33294570 PMCID: PMC7700974 DOI: 10.1016/j.jdcr.2020.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
| | - Andrea López
- University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Erika Watts
- Department of Dermatology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
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Dietze L, Metze D, Goerge T. Eosinophile Fasziitis – eine seltene Differenzialdiagnose bei venösen Symptomen. PHLEBOLOGIE 2020. [DOI: 10.1055/a-1171-5047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ZusammenfassungEin 26-jähriger Sportler stellte sich in unserer phlebologischen Ambulanz zur Diagnostik und Therapie bei sichtbarer Varikosis am linken Bein vor. Sonografisch stellte sich eine insuffiziente Vena saphena magna links dar. Es wurde eine VNUS-Closure der VSM links komplikationslos durchgeführt. Trotz sonografisch unauffälligen Kontrollen berichtet der Patient im weiteren Verlauf über ein zunehmendes Schweregefühl und eine Verhärtung der Haut. In der Histologie konnte eine eosinophile Fasziitis nachgewiesen werden. Bisher gibt es keine Berichte zum Zusammenhang von chronisch-venöser Insuffizienz, der endoluminalen Behandlung und eosionphiler Fasziitis. Der Fallbericht stellt eine seltene, aber in diesem Fall wichtige Differenzialdiagnose bei postinterventionellen venösen Beschwerden dar.
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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.
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Yamamoto T, Ito T, Asano Y, Sato S, Motegi SI, Ishikawa O, Matsushita T, Takehara K, Makino T, Okiyama N, Fujimoto M, Jinnin M, Ihn H. Characteristics of Japanese patients with eosinophilic fasciitis: A brief multicenter study. J Dermatol 2020; 47:1391-1394. [PMID: 32860239 DOI: 10.1111/1346-8138.15561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 07/14/2020] [Indexed: 12/11/2022]
Abstract
Eosinophilic fasciitis is a relatively rare cutaneous fibrotic condition affecting the deep fascia of the extremities, with or without peripheral blood eosinophilia. To examine the characteristics of Japanese patients with eosinophilic fasciitis, we conducted a brief, multicenter, retrospective survey at seven university hospitals. In total, 31 patients were identified as having eosinophilic fasciitis, among whom 30 patients fulfilled the Japanese diagnostic criteria. The male : female ratio was 2.3:1, and the mean age was 47.7 years. Three of the patients were under 20 years old. The possible triggering factors included muscle training, sports, walking or sitting for a long time, physical work, insect bite and drug. Co-occurrence of morphea was observed in nine cases (29%), and malignancies were associated in three (two hematological malignancies and one internal malignancy). Immunological abnormalities in the serum showed positive antinuclear antibody, positive rheumatoid factor, increased aldolase levels and increased immunoglobulin G levels. The patients were treated with either monotherapy or combination therapy by oral prednisolone (20-80 mg/day), methotrexate (6-10 mg/week), cyclosporin (100-150 mg/day), mizoribine, infliximab and phototherapy. Methylprednisolone pulse therapy was performed in six cases. By contrast, spontaneous improvement due to resting only was observed in two cases, and skin hardening was improved by withdrawal of the anticancer drug in one case. This study suggests several characteristics of Japanese patients with eosinophilic fasciitis, namely male predominance, rare pediatric occurrence, immunological abnormalities and coexistence with morphea. Systemic prednisolone is the first-line therapy, but pulse therapy is occasionally required for severe cases. The triggering events of physical stress are not so frequent as have previously been reported, and various factors or even unknown factors may be associated with the induction of eosinophilic fasciitis.
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Affiliation(s)
- Toshiyuki Yamamoto
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - Takashi Ito
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - Yoshihide Asano
- Department of Dermatology, University of Tokyo, Tokyo, Japan
| | - Shinichi Sato
- Department of Dermatology, University of Tokyo, Tokyo, Japan
| | | | - Osamu Ishikawa
- Department of Dermatology, Gunma University, Maebashi, Japan
| | | | | | | | - Naoko Okiyama
- Department of Dermatology, Tsukuba University, Tsukuba, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Tsukuba University, Tsukuba, Japan.,Department of Dermatology, Osaka University, Osaka, Japan
| | - Masatoshi Jinnin
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Hironobu Ihn
- Department of Dermatology, Kumamoto University, Kumamoto, Japan
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The use of tocilizumab in the treatment of refractory eosinophilic fasciitis: a case-based review. Clin Rheumatol 2020; 39:1693-1698. [PMID: 31974818 DOI: 10.1007/s10067-020-04952-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/15/2020] [Accepted: 01/17/2020] [Indexed: 12/21/2022]
Abstract
Eosinophilic fasciitis (EF) is a rare disorder involving chronic inflammation of the fascia and connective tissue of unknown aetiology and poorly understood pathogenesis. We present the case of a 60-year-old man diagnosed with eosinophilic fasciitis with extensive cutaneous involvement and severe functional repercussion, which appeared weeks after suffering from pneumonia due to Legionella pneumophila. The patient did not experience any clinical response with high-dose corticosteroids, subcutaneous methotrexate, and intravenous immunoglobulins. Consequently, tocilizumab was initiated at 8 mg/Kg monthly achieving clinical response measured by a control MRI at the fifth dose. Response in terms of cutaneous thickness has been slower however favourable, therefore, more months of follow-up are necessary to assess the complete remission at skin level. EF treatment still constitutes a challenge, and experience with tocilizumab in the management of the disease is very limited. Through a systematic search of medical literature, we retrieved two cases describing EF treated with tocilizumab and several cases using another monoclonal antibody or Janus kinase inhibitor. We report the third case to our knowledge of the efficacy of tocilizumab in a refractory EF to corticosteroids and other immunosuppressive drugs.
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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.
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Affiliation(s)
- Timothy Prossor
- London North West University Healthcare NHS Trust, London, UK
| | | | | | - Melanie Dani
- Imperial College Healthcare NHS Trust, London, UK
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Nakajima H. Recent advances in eosinophil-related diseases. Allergol Int 2019; 68:401-402. [PMID: 31590764 DOI: 10.1016/j.alit.2019.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Indexed: 11/17/2022] Open
Affiliation(s)
- Hiroshi Nakajima
- Department of Allergy and Clinical Immunology, Chiba University, Chiba, Japan.
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40
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[Sclerosing skin diseases]. Internist (Berl) 2019; 60:783-791. [PMID: 31292667 DOI: 10.1007/s00108-019-0643-2] [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: 10/26/2022]
Abstract
Sclerosing skin manifestations are more a symptom than a diagnosis and must therefore be meticulously clarified. Systemic scleroderma as a multiorgan disease must be distinguished from localized scleroderma or morphea because in addition to a different clinical picture they have a different prognosis and necessitate other therapeutic procedures. Rare sclerosing skin diseases with implications for internal medicine are eosinophilic fasciitis, Buschke's scleredema adultorum, scleromyxedema and nephrogenic systemic fibrosis.
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Wollina U, Hansel G, Schönlebe J, Heinig B, Temelkova I, Tchernev G, Vojvocic A, Lotti T. Eosinophilic Fasciitis - Report of Three Cases and Review of the Literature. Open Access Maced J Med Sci 2019; 7:2964-2968. [PMID: 31850100 PMCID: PMC6910797 DOI: 10.3889/oamjms.2019.296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/03/2019] [Accepted: 05/04/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND: Eosinophilic fasciitis is a rare fibrosing disorder of muscle fascia with rapid onset of erythema, induration, oedema and tenderness affecting extremities bilaterally. CASE REPORT: We report three cases of eosinophilic fasciitis in 3 females aged 64, 65 and 73 years, in two of them in association with morphea. They fulfilled the proposed diagnostic criteria. Associated malignancies could be excluded in all of them. They were treated by systemic corticosteroids. In the two females with associated morphea higher prednisolone dosages and a combination with methotrexate was necessary. CONCLUSIONS: Eosinophilic fasciitis is a differential diagnosis of systemic scleroderma. Response to treatment is often delayed. Systemic corticosteroids are the first line therapy. Patients with associated morphea need combined drug therapy, in our patients with methotrexate. There is no close correlation between laboratory signs of inflammation and clinical response to treatment.
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Affiliation(s)
- Uwe Wollina
- Städtisches Klinikum Dresden, Department of Dermatology and Allergology, Dresden, Germany
| | - Gesina Hansel
- Städtisches Klinikum Dresden, Department of Dermatology and Allergology, Dresden, Germany
| | - Jacqueline Schönlebe
- Institute of Pathology "Georg Schmorl", Städtisches Klinikum Dresden, Academic Teaching Hospital, Dresden, Germany
| | - Birgit Heinig
- Center of Physical and Rehabilitative Medicine, Städtisches Klinikum Dresden, Academic Teaching Hospital, Dresden, Germany
| | - Ivanka Temelkova
- Onkoderma - Clinic for Dermatology, Venereology and Dermatologic Surgery, General Skobelev 26, 1606, Sofia, Bulgaria
| | - Georgi Tchernev
- Onkoderma - Clinic for Dermatology, Venereology and Dermatologic Surgery, General Skobelev 26, 1606, Sofia, Bulgaria
| | - Aleksandra Vojvocic
- Department of Dermatology and Venereology, Military Medical Academy of Belgrade, Belgrade, Serbia
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