“…The role of environmental factors has also been suspected in the context of EF, although no case-control study is available. In case reports, EF has been linked to infection with Borrelia species , 2 , 9 , 47 , 51 , 87 , 107 , 116 brucellosis, 90 chronic hepatitis C, 90 tertiary syphilis, 90 chemical exposure, 11 trichloroethylene, 52 insect bites, 79 , 90 irradiation, 109 and various pharmaceuticals, including simvastatin, 28 , 108 phenytoin, 18 atorvastatin, 31 fosinopril, 10 alpha-methyldopa, 90 subcutaneous heparin use, 20 and antituberculosis therapy. 104 Geographical clustering of scleroderma-like syndromes, including EF, was reported in a rural area in Italy.…”