Remitting fasciitis without eosinophilia: a new disease entity? A case report

Ohno, Maiko; Nagaoka, Shohei; Onari, K.; Kitamura, Hiroyuki; Hachiya, M.; Kondo, S.; Ishigatsubo, Y.

doi:10.1093/rheumatology/40.12.1428

Cited by 5 publications

(2 citation statements)

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“…Eosinophilic infiltrates are present in 69–75% of patients, but their presence is not mandatory for the diagnosis of EF . Eosinophils can be absent in the chronic stage of the disease , after treatment with glucocorticoids , or in the context of profound leukopenia as in our patient.…”

Section: Discussionmentioning

confidence: 66%

Skin Induration in a Patient With Aplastic Anemia

Kastsianok

Ranganathan

2018

Arthritis Care & Research

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A 58-year-old man presented to the rheumatology clinic for evaluation of skin induration of 6 months duration. History of present illnessOne month prior to rheumatology evaluation he was admitted to the hospital for progressive worsening of shortness of breath on exertion, epistaxis, and gingival bleeding. He had fatigue, poor appetite, and an unintentional weight loss of approximately 30 pounds over the preceding 2 years. He denied symptoms of chest pain, orthopnea, paroxysmal nocturnal dyspnea, or leg swelling. Laboratory tests during that admission showed profound leukopenia of 2.2 9 10 3 /mm 3 (normal range 3.8-9.8), macrocytic anemia with hemoglobin of 5.9 gm/dl (normal range 13.8-17.2), hematocrit of 17.3% (normal range 40.7-50.3), mean corpuscular volume (MCV) of 107.7 fl (normal range 80-100), and thrombocytopenia of 3 9 10 3 /mm 3 (normal range 140-440). He underwent bone marrow biopsy, which showed aplastic anemia. He received packed red blood cell and platelet transfusions with improvement of hemoglobin and hematocrit to 7.3 gm/dl and 21.6%, respectively, and platelet counts to 32 9 10 3 /mm 3 . He was discharged to followup with hematology.In the last 6 months, he had noticed induration of the skin over his chest, abdomen, low back, arms, and thighs, and stiffness in the upper and lower extremities because of the skin induration. These areas were not painful or itchy. He had difficulty raising his arms above the level of his shoulders due to the skin changes. Laboratory, histopathology, and radiologic evaluationAt the time of his rheumatologic evaluation, laboratory results were significant for a macrocytic anemia with

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Section: Discussionmentioning

confidence: 66%

Skin Induration in a Patient With Aplastic Anemia

Kastsianok

Ranganathan

2018

Arthritis Care & Research

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“…The diagnosis of EF is confirmed by a deep biopsy, skin to muscle, which shows fibrosis of the fascia and an infiltrate of lymphocytes, histiocytes, plasma cells, and eosinophils localized within the dermis, fascia, epimysium, perimysium or endomysium. Of note, eosinophils are not required for the diagnosis of EF; eosinophilic infiltration and peripheral eosinophilia may be absent at the chronic stage of the disease [13], or after CS treatment [14], as most likely was the case with our patient. Membrane attack complex C5b9 deposits, described in our patient's muscle biopsy, are usually seen in dermatomyositis and point toward an immune-based myopathy.…”

Section: Clinical Discussionmentioning

confidence: 97%

Anti-neutrophil Cytoplasmic Antibody (c-ANCA) Positive Recurrent Eosinophilic Fasciitis Responsive to Cyclophosphamide

Haiduc

Erkan

Kirou

et al. 2008

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Finger stiffness or edema as presenting symptoms of eosinophilic fasciitis

et al. 2015

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To investigate the clinical features and finger symptoms of eosinophilic fasciitis (EF), we reviewed five patients with EF. The chief complaint was pain, edema and/or stiffness of the extremities. The distal extremities were affected in all patients, and there was also proximal involvement in one patient. One patient had asymmetrical symptoms. All four patients with upper limb involvement had limited range of motion of the wrist joints, and three of them complained of finger symptoms. Two of these three patients showed slight non-pitting edema of the hands, and the other one had subcutaneous induration of the forearm. All four patients with lower limb symptoms had limited range of motion of the ankle joints, and two showed edema or induration of the legs. Inflammatory changes in the joints were not detected in any of the patients. Two patients displayed neither objective induration nor edema, and two patients had muscle tenderness. In conclusion, finger symptoms of patients with EF might be caused by fasciitis of the forearms, which leads to dysfunction of the long finger flexors and extensors as well as slight edema of hands. Limited range of motion of wrist and/or ankle joints indicates sensitively distal muscle dysfunction caused by fasciitis.

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Remitting fasciitis without eosinophilia: a new disease entity? A case report

Cited by 5 publications

References 1 publication

Skin Induration in a Patient With Aplastic Anemia

Skin Induration in a Patient With Aplastic Anemia

Anti-neutrophil Cytoplasmic Antibody (c-ANCA) Positive Recurrent Eosinophilic Fasciitis Responsive to Cyclophosphamide

Finger stiffness or edema as presenting symptoms of eosinophilic fasciitis

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