Generalized morphea/eosinophilic fasciitis overlap after epoxy exposure

Abstract

Generalized morphea is associated with epoxy resin vapors and is characterized by the development of lesions shortly after exposure. Morphea presenting along with eosinophilic fasciitis (EF), or morphea/EF overlap, is rare and an indicator of poor prognosis and resistance to treatment. Here we present a case of generalized morphea/EF overlap linked to epoxy exposure. Our patient received multiple therapies—ultraviolet A1 phototherapy, prednisone, methotrexate, azathioprine, mycophenolate mofetil, cyclophosphamide, cyclosporine, and rituximab—none of which led to a significant response. The refractory nature of this disease warrants vigilance in its association with epoxy exposure.

A Severe Case of Overlap of Morphea and Eosinophilic Fasciitis after Burn Injuries

“…Gutierrez et al discussed a case of a 71-year-old who presented with a one-year history of skin tightening and was found to have eosinophilia, hypergammaglobulinemia, and diminished CD34 expression on pathology, treated with intravenous immunoglobulins (IVIG) with marked improvement within months [ 17 ]. Heidary et al reported a case of a 50-year-old lady with three months of violaceous plaques and induration, decreased CD34 expression, and absence of peripheral eosinophilia who eventually responded to treatment with methotrexate, steroids, and etanercept [ 18 ]. In this case, the biopsy was more suggestive of morphea, but based on clinical progression, the patient was diagnosed with both morphea and EF.…”

A case of eosinophilic fasciitis and generalized morphea overlap

“…Eosinophilic fasciitis is occasionally induced by vigorous exercise as well as trauma, leading to the hardening of the skin and limited range of movement in the joints. Eosinophilic fasciitis is often regarded to belong to the severe end of the morphea spectrum [1] and an association with morphea has been reported in 19-41% of eosinophilic fasciitis In contrast, generalized morphea is rarely seen, and to our knowledge only seven cases of concurrent eosinophilic fasciitis and generalized morphea have been reported in the English literature [5][6][7][8][9][10]. The patient characteristics of these reported cases are shown in Table 1.…”