Iron Lady: A Case of Eosinophilic Fasciitis

Abstract

Eosinophilic Fasciitis is a rare rheumatologic disease usually characterized by erythema and limbs' pain, cutaneous induration and peripheral eosinophilia. However, it is important to consider Eosinophilic Fasciitis in differential diagnosis of others sclerodermalike syndromes. The authors present a case of a 52-year-old woman who presented to our hospital with a four months evolution of limb and trunk diffuse symmetrical cutaneous induration, thickening of the skin without joint involvement and no history of Raynaud's phenomenon. On physical examination, she had a grade 3 skin thickening in the involved segments. Laboratory studies revealed no peripheral eosinophilia. The biopsy showed fibrotic involvement of muscle and fascia, with a few inflammatory infiltrations of lymphocytes. She started prednisolone 1 mg/kg/day, with partial regression of cutaneous injuries. As Eosinophilic Fasciitis is so rare, its recognition can be difficult, especially when the patient is observed at a late stage where the peripheral eosinophilia and inflammatory infiltration in the histology are usually no longer present. A clinical history and a detailed physical examination, especially with the presence of orange peel skin, are the fundamental clues for the diagnosis.