IJD
Indian Journal of Dermatology
  Publication of IADVL, WB
  Official organ of AADV
Indexed with Science Citation Index (E) , Web of Science and PubMed
 
Users online: 1306  
Home About  Editorial Board  Current Issue Archives Online Early Coming Soon Guidelines Subscriptions  e-Alerts    Login  
    Small font sizeDefault font sizeIncrease font size Print this page Email this page


 
Table of Contents 
CORRESPONDENCE
Year : 2020  |  Volume : 65  |  Issue : 5  |  Page : 427-429
A case of eosinophilic fasciitis presenting with palmar stiffness


1 Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
2 Department of Pathology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran

Date of Web Publication11-Aug-2020

Correspondence Address:
Anahita Rostami
Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran
Iran
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.IJD_446_18

Rights and Permissions



How to cite this article:
Nasimi M, Naragh ZS, Rostami A. A case of eosinophilic fasciitis presenting with palmar stiffness. Indian J Dermatol 2020;65:427-9

How to cite this URL:
Nasimi M, Naragh ZS, Rostami A. A case of eosinophilic fasciitis presenting with palmar stiffness. Indian J Dermatol [serial online] 2020 [cited 2020 Oct 29];65:427-9. Available from: https://www.e-ijd.org/text.asp?2020/65/5/427/291823




Sir,

Eosinophilic fasciitis (EF) is a rare disease which is characterized by painful, progressive, symmetrical swelling, and induration of the skin.[1]

Although EF usually spares the fingers, there are some reports about involvement of the distal extremities.[1] Here is an unusual case of EF with palmar stiffness.

The patient was a 35-year-old man, with sudden onset of skin stiffness arising from the abdomen, which also involved the arms, elbows, palms, and neck. Cutaneous lesions also extended to lower extremities from the knees to the ankles bilaterally, within about 1 month. The patient complained of stiffness and difficulty in mobility of the hands, fingers, and elbow joints [Figure 1].
Figure 1: Flexion contracture of elbow and interphalangeal joints

Click here to view


The laboratory investigation revealed white blood cell count of 16.2 ×109/L and eosinophil count of 1.458 ×109/L (9% of white blood cells).

A full thickness skin biopsy was obtained and showed thickened collagen bundles extending to deep dermis and fascia with numerous eosinophilic infiltration [Figure 2] and [Figure 3].
Figure 2: Eosinophilic infiltration within the deep dermis and subcutaneous tissue (H and E, ×40)

Click here to view
Figure 3: Eosinophilic infiltration within the subcutaneous tissue (H and E, ×400)

Click here to view


The patient underwent treatment with 60 mg of prednisolone and 15 mg of methotrexate weekly. After 2 weeks, the symptoms were relieved, and the patient was discharged with oral medication.

In contrast to the previous reports, our patient had palmar stiffness without any evidence in favor of systemic sclerosis, such as sclerodactyly, Raynaud's phenomenon, and nail fold telangiectasia.

Based on our search, there was a report of three cases with EF by Suzuki et al. with hand involvement and decrease of range of joint movement along with palmar nonpitting edema, as was observed in our patient.[1] The author believed that these symptoms are related to forearm fasciitis, and the compression effect on the venous return caused finger edema and are not related to true sclerotic changes.[1]

There were other reports of cases with EF which involved all the digits and caused flexion contracture of the finger joints.[2],[3],[4]

In conclusion, this is a case of EF with atypical symptoms presenting with palmar stiffness, in addition to classic symptoms of upper and lower extremities joint stiffness.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Suzuki S, Noda K, Ohira Y, Shikino K, Ikusaka M. Finger stiffness or edema as presenting symptoms of eosinophilic fasciitis. Rheumatol Int 2015;35:1769-72.  Back to cited text no. 1
    
2.
Huppke P, Wilken B, Brockmann K, Sattler B, Hanefeld F. Eosinophilic fasciitis leading to painless contractures. Eur J Pediatr 2002;161:528-30.  Back to cited text no. 2
    
3.
Pillen S, van Engelen B, van den Hoogen F, Fiselier T, van der Vossen P, Drost G. Eosinophilic fasciitis in a child mimicking a myopathy. Neuromuscul Disord 2006;16:144-8.  Back to cited text no. 3
    
4.
Pardos-Gea J. Positive prayer sign in eosinophilic fasciitis. Rheumatology (Oxford) 2017;56:628.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

Top
Print this article  Email this article
 
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (1,319 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    References
    Article Figures

 Article Access Statistics
    Viewed175    
    Printed6    
    Emailed0    
    PDF Downloaded18    
    Comments [Add]    

Recommend this journal