Eosinophilic Fasciitis: What Matters in Management in a Developing Country—A Case Report with Two and a Half-year Follow-up

Islam, Md. Nazrul; Islam, Md. Ariful; Abdal, Syed Jamil; Azad, Mohammad Abul Kalam; Ahmedullah, Abul Khair; Haq, Syed Atiqul

doi:10.3329/jhpn.v30i1.11292

Cited by 7 publications

(7 citation statements)

References 10 publications

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“…Peripheral blood eosinophilia, hypergammaglobulinemia and elevated ESR and serum aldolase levels are the main laboratory findings [ 9 , 11 ]. Marked eosinophilia may be an early but temporary finding in the course of the disease [ 12 ]. In one series, peripheral blood eosinophilia was seen in 33 of 52 patients, hypergammaglobulinemia in 17 of 49 and elevated ESR in 15 of 52 [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Immune Checkpoint Inhibitor-Associated Scleroderma-Like Syndrome: A Report of a Pembrolizumab-Induced “Eosinophilic Fasciitis-Like” Case and a Review of the Literature

2020

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Immune checkpoint inhibitors are a promising new therapeutic strategy in oncology that aims to eliminate cancer cells by enhancing patients' immune response against tumor antigens. Despite their beneficial effects, immune checkpoint inhibitors are also responsible for a plethora of autoimmune manifestations, known as immune-related adverse events. We present a case of eosinophilic fasciitis-like disorder in an 81-year-old patient treated with the programmed death cell protein 1 inhibitor pembrolizumab for non-small-cell lung cancer. The patient developed characteristic indurated skin lesions in his limbs after 1½ years of treatment with pembrolizumab and a typical “groove sign.” Raynaud’s syndrome was absent. A full-thickness biopsy confirmed the clinical diagnosis of an “EF-like” condition. Neither peripheral eosinophilia nor eosinophilic infiltrates in the skin biopsy were found. His symptoms improved after a 2.5-month CPI discontinuation and treatment with 16 mg of methylprednisolone slowly tapered to a dose of 4 mg. Eosinophilic fasciitis is a rare immune-related adverse event of CPI treatment; our literature search identified only 12 cases that fulfill the criteria of EF in patients receiving CPIs.

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Section: Discussionmentioning

confidence: 99%

Immune Checkpoint Inhibitor-Associated Scleroderma-Like Syndrome: A Report of a Pembrolizumab-Induced “Eosinophilic Fasciitis-Like” Case and a Review of the Literature

2020

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“…Laboratory findings include peripheral eosinophilia in 60-90% of cases 1 , hypergammaglobulinemia and increased erythrocyte sedimentation rate (ESR). 7 No antibodies are detected, such as ANA or anti-SCL 70. Eosinophil counts may be very high, but are not associated with disease prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…Spontaneous resolution occurs in 10-20% of patients after two to five years of disease; in the other cases, treatment should include physical therapy associated with immunomodulatory medication. 7 High doses of glucocorticoid (equivalent dose of 1 mg/kg/day of prednisone) are described as first-line treatment. In recurrent cases or incomplete response, hydroxychloroquine can be associated with cyclosporine A.…”

Section: Discussionmentioning

confidence: 99%

Eosinophilic fasciitis

Lamback¹,

Resende²,

Lenzi

2016

An. Bras. Dermatol.

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Eosinophilic fasciitis is a rare sclerodermiform syndrome of unknown etiology. It is characterized by the thickening of the muscular fascia and subcutaneous tissue, with a variable infiltration of eosinophils. Peripheral eosinophilia, poly or monoclonal hypergammaglobulinemia and increased erythrocyte sedimentation rate can be seen. Clinical features begin acutely, with local edema and a painful and symmetrical stiffening of the limbs, progressing rapidly to fibrosis, which can limit joint movements. Some cases have a history of strenuous physical exercise or trauma. The diagnosis is confirmed by a deep skin biopsy. Glucocorticoids in high doses is the treatment of choice. We report a typical eosinophilic fasciitis case with peripheral eosinophilia and dramatic response to pulse therapy with methylprednisolone.

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“…However, there are also non‐responders, and it is vital to be aware of adverse reactions due to penicillamine . The efficacy of chloroquine or hydroxychloroquine has also been suggested, but there have also been non‐responders to this treatment . In one study, 12 out of 14 patients who concurrently used colchicine with steroids and immunosuppressants were reported to have achieved complete remission .…”

Section: Guidelines For the Treatmentmentioning

confidence: 99%

Diagnostic criteria, severity classification and guidelines of eosinophilic fasciitis

Jinnin

Yamamoto

Asano

et al. 2017

The Journal of Dermatology

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We established diagnostic criteria and severity classification of eosinophilic fasciitis because there is no established diagnostic criteria or widely accepted severity classification of the disease. Also, there has been no clinical guideline for eosinophilic fasciitis, so we established its clinical guideline ahead of all over the world. In particular, the clinical guideline was established by clinical questions based on evidence-based medicine according to the New Minds Clinical Practice Guideline Creation Manual (version 1.0). We aimed to make the guideline easy to use and reliable based on the newest evidence, and to present guidance as specific as possible for various clinical problems in treatment of eosinophilic fasciitis.

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Eosinophilic Fasciitis: What Matters in Management in a Developing Country—A Case Report with Two and a Half-year Follow-up

Cited by 7 publications

References 10 publications

Immune Checkpoint Inhibitor-Associated Scleroderma-Like Syndrome: A Report of a Pembrolizumab-Induced “Eosinophilic Fasciitis-Like” Case and a Review of the Literature

Immune Checkpoint Inhibitor-Associated Scleroderma-Like Syndrome: A Report of a Pembrolizumab-Induced “Eosinophilic Fasciitis-Like” Case and a Review of the Literature

Eosinophilic fasciitis

Diagnostic criteria, severity classification and guidelines of eosinophilic fasciitis

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