From diagnosis to remission: place of MRI in eosinophilic fasciitis

Abstract

Eosinophilic fasciitis is a rare disease, but it must be considered in patients with adult myalgia. Here, we report the case of 32-year-old man who presented with a 4-month history of bilateral myalgia of the lower limbs, which subsequently spread to the upper limbs. There was no specific medical history, no trauma, and no intense activity. Physical examination revealed induration of the skin with irreducible flexion of the fingers as observed in scleroderma. Laboratory examination showed peripheral eosinophilia associated with moderate elevation of both the erythrocyte sedimentation rate and C-reactive protein. No infectious, neoplastic, hemopathic, or immunological abnormality was detected. Magnetic resonance imaging (MRI) showed thickening of the muscular fascias of the thigh in high signal intensity on T2-weighted images, slightly enhanced after contrast agent injection on T1 images, without myositis. MRI-guided muscle biopsy demonstrated fascia infiltration characterized by mononuclear inflammatory cells and polynuclear eosinophils. A diagnosis of eosinophilic fasciitis was confirmed and the patient received prednisolone. One month later, he reported improvements in general health, pain, motion, joint mobility, and skin induration associated with normalization of both hypereosinophilia and biologic inflammation. After 12 months, clinical MRI and laboratory parameters were normal and the patient was considered to be in clinical remission.

Eosinophilic Fasciitis: A Rare Skin Sclerosis

“…MRI is useful for guided muscle biopsy [14, 15] which should be performed to confirm the diagnosis (deep skin biopsy, ideally down to muscle).…”

Trismus secondaire à une fasciite à éosinophiles : un cas et revue de la littérature

“…L'éosinophilie tissulaire n'est pas impérative pour retenir le diagnostic [1,4,[6][7][8][9] et elle semble corrélée à l'éosi-nophilie sanguine [9]. L'imagerie joue un rôle de plus en plus important dans le diagnostic et le suivi de la fasciite à éosi-nophiles [11][12][13]. L'IRM permet de mettre en évidence une fasciite, une myosite associée, et guide la biopsie en ciblant la zone de prélèvement optimale [11,12].…”

“…L'imagerie joue un rôle de plus en plus important dans le diagnostic et le suivi de la fasciite à éosi-nophiles [11][12][13]. L'IRM permet de mettre en évidence une fasciite, une myosite associée, et guide la biopsie en ciblant la zone de prélèvement optimale [11,12]. Le TEP scan [13] et les ultrasons [14] ont eux aussi été récemment proposés.…”

Morphea and Eosinophilic Fasciitis: An Update

“…The post-therapy images ( n  = 3) showed marked improvement in two and mild but definite improvement in the other [136]. Case reports confirm the added value of MRI for both diagnostic purposes [137] and for the assessment of the fasciitis [39, 138]. In addition, ultrasound [41, 42] and positron emission tomography (PET) [43–45] have also been reported to be helpful for similar purposes.…”