Ann Dermatol.  2011 Feb;23(1):81-84. 10.5021/ad.2011.23.1.81.

Two Cases of Eosinophilic Fasciitis

Affiliations
  • 1Department of Dermatology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. cjpark777@yahoo.co.kr
  • 2Department of Radiology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Abstract

Eosinophic fasciitis (EF) is an uncommon connective tissue disease characterized by scleroderma-like cutaneous changes, peripheral eosinophilia, hypergammaglobulinemia, and an elevated erythrocyte sedimentation rate (ESR). Typical histopathologic findings include chronic inflammatory infiltration affecting the deep fascia with lymphocytes, histiocytes, and occasionally eosinophils. We report two cases of EF, the first of which is a 36-year-old man with a tender brownish induration on both forearms, for 2 months. Histopathologic examination showed fibrotic fascia with a mixed inflammatory cell infiltration. The second case is a 52-year-old woman with a symmetrical painful swelling and skin induration on both forearms, for 4 months. A deep biopsy demonstrated chronic inflammatory cell infiltration and hyaline degeneration in the fascia. Increased signal intensity in the fascia and tendon sheath was shown on magnetic resonance imaging. In laboratory examination, mild eosinophilia was found in both cases. Both patients had a history of physical activity (weight training and excessive housework, respectively) and showed marked improvement with high doses of oral prednisolone for several months.

Keyword

Eosinophilic fasciitis; Excessive physical activity; Magnetic resonance imaging (MRI)

MeSH Terms

Adult
Biopsy
Blood Sedimentation
Connective Tissue Diseases
Eosinophilia
Eosinophils
Fascia
Fasciitis
Female
Forearm
Histiocytes
Housekeeping
Humans
Hyalin
Hypergammaglobulinemia
Lymphocytes
Magnetic Resonance Imaging
Middle Aged
Motor Activity
Prednisolone
Skin
Tendons
Eosinophilia
Fasciitis
Prednisolone

Figure

  • Fig. 1 (A) Tender, brownish induration on both forearms. (B) A deep tissue biopsy specimen from the lesion shows chronic inflammation with fibrosis (H&E, ×25). (C) The fascia is fibrotic with mixed inflammatory cell infiltration (H&E, ×100). (D) Mixed inflammatory cell infiltration composed of lymphohistiocytes and plasma cells (H&E, ×400).

  • Fig. 2 (A) Symmetrical, painful swelling and skin induration on both forearms. (B) The fascia shows thickening with chronic inflammatory cell infiltration and hyaline degeneration (H&E, ×25). (C) Infiltration of lymphohistiocytes and plasma cells in the fascia (H&E, ×400). (D) Contrast-enhanced fat-suppressed T1-weighted axial magnetic resonance image of the left wrist shows strong enhancement along the superficial and deep intermuscular fascia, extensor and flexor tendon sheath (arrows).


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