Eosinophilic Fasciitis Associated with Autoimmune Thyroiditis

Abstract

Eosinophilic fasciitis (EF) is scleroderma-like disease without Raynaud's phenomenon or visceral involvement. It is characterized by painful swelling of the extremities, accompanied by rapid weight gain, fever and myalgia. The acute state of disease is associated with significant peripheral blood eosinophilia, an elevated erythrocyte sedimentation rate and hypergammaglobulinemia. EF is also frequently associated with hematological abnormalities, including malignant lymphoproliferative diseases, but rarely associated with autoimmune thyroiditis. In the present study we report a case of eosinophilic fasciitis associated with autoimmune thyroiditis.

Severe Aplastic Anemia Associated With Eosinophilic Fasciitis

“…Two patients had Hashimoto thyroiditis, 2 , 13 and 2 others (Patient 4 and a patient reported previously 30 ) had ulcerative colitis. Hashimoto thyroiditis 5 , 13 , 59 , 114 and Crohn disease 82 have been previously reported as associated with EF but not AA in some case reports. AA is rarely associated with other immune diseases; in a retrospective survey of 1251 patients with AA, only 50 (4%) had prior autoimmune disease diagnoses.…”

“…EF is sometimes associated with hematologic diseases, particularly with aplastic anemia (AA) (n = 19), 2 , 13 , 15 , 22 , 24 , 30 , 33 , 38 , 57 , 58 , 73 , 77 , 89 , 95 , 111 , 117 , 128 but also with T-cell lymphoma (n = 5), 27 , 36 , 65 , 72 , 83 cutaneous T-cell lymphoma (n = 1), 25 Hodgkin disease (n = 3), 84 , 90 , 98 myeloproliferative syndromes (n = 3), 61 , 75 , 85 myelomonocytic leukemia (n = 2), 75 , 85 chronic lymphocytic leukemia (n = 2), 12 , 75 multiple myeloma (n = 1), 68 and myeloblastic leukemia (n = 1), 90 and, less commonly, with solid tumors such as breast cancer (n = 5), 12 , 90 , 109 , 127 choroidal melanoma (n = 1), 125 colorectal cancer (n = 1), 94 and prostate cancer (n = 1). 90 Diffuse EF has also been reported in association with autoimmune disorders, such as Hashimoto thyroiditis (n = 6), 2 , 5 , 13 , 59 , 114 systemic lupus erythematosus (n = 4), 6 , 43 , 45 , 74 Crohn disease (n = 1), 82 Graves disease (n = 1), 114 glomerulonephritis (n = 1), 63 rheumatoid arthritis (n = 1), 81 type 1 diabetes (n = 1), 46 and autoimmune cytopenias, including autoimmune hemolytic anemia (n = 2), 5 , 44 immune thrombocytopenic purpura (n = 2), 5 , 111 amegakaryocytic thrombocyt...…”

Use of H-1 Antihistamine in Dermatology: More than Itch and Urticaria Control: A Systematic Review

“…Eosinophilia is a prominent laboratory finding in the early phase of eosinophilic fasciitis [ 43 ]. Several case reports mentioned the effect of antihistamines, such as ketotifen [ 44 ], hydroxyzine [ 45 ], and cetirizine [ 46 ] in eosinophilic fasciitis. The initiation of hydroxyzine in one 3-year-old boy not only improved clinical symptoms but also reversed peripheral blood eosinophilia, which indicates inhibition of eosinophil migration as the mechanism of the effectiveness in eosinophilic fasciitis [ 45 ].…”

Morphological Clues in the Diagnosis of Sclerodermiform Dermatitis

“…Accompanying autoimmune conditions have been described in association with EF, including thyroiditis, 1,[17][18][19] diabetes mellitus, 19 cytopenias, 17,20 and connective tissue diseases. [21][22][23][24] Indeed, the autoimmune mechanism is the most accepted hypothesis.…”