Eosinophilic fasciitis: an atypical presentation of a rare disease

SUMMARY Eosinophilic fasciitis, or Shulman's disease, is a rare disease of unknown etiology. It is characterized by peripheral eosinophilia, hypergammaglobulinemia, and high erythrocyte sedimentation rate. The diagnosis is confirmed by a deep biopsy of the skin. The first line of treatment is corticotherapy. We present a rare case of eosinophilic fasciitis in a 27-year-old woman with an atypical presentation with symmetrical peripheral edema and a Groove sign. The patient responded well to treatment with corticosteroids at high doses and, in this context, was associated with hydroxychloroquine and azathioprine. After two and a half years, peripheral eosinophilia had increased, and more of her skin had hardened. At that time, the therapy was modified to include corticoids, methotrexate, and penicillamine. It is of great importance to publicize these cases that allow us to gather experience and better treat our patients.

RESUMO A fasciite eosinofílica ou doença de Shulman é uma doença rara de etiologia desconhecida. É caracterizada por eosinofilia periférica, hipergamaglobulinemia e velocidade de sedimentação eritrocitária elevada. O diagnóstico é confirmado por biópsia profunda da pele. O tratamento de primeira linha é a corticoterapia. Apresentamos um caso raro de fasciite eosinofílica numa mulher de 27 anos com uma apresentação atípica com edema periférico simétrico e sinal de Groove. A paciente respondeu bem ao tratamento com corticoides, mas em doses elevadas, e, nesse contexto, associou-se hidroxicloroquina e azatioprina. Ao fim de dois anos e meio verificou-se aumento de eosinofilia e novamente pele mais endurecida. Nessa altura alterou-se a terapêutica para corticoides, metrotexato e penicilamina. É de grande importância a divulgação desses casos que nos permitem reunir experiência e assim melhor tratar os nossos doentes.

Eosinophilic fasciitis

Abstract 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.

Local injection of autologous platelet rich plasma and corticosteroid in treatment of lateral epicondylitis and plantar fasciitis: randomized clinical trial

This randomized controlled study was designed to compare the effectiveness of local injection of autologous platelet rich plasma [PRP] and local steroid in reducing pain and improving function in a cohort of patients with tennis elbow [TE] and plantar fasciitis [PF]. The study population comprised two groups; Group 1 patients with TE [n = 30] and Group 2 patients with PF [n = 30]. In each group patients were allocated randomly to receive either a steroid or PRP injections. All patients filled in visual analog scale [VAS], disability of arm, shoulder and hand [DASH] score for TE and foot health status questionnaire [FHSQ] for PF at base line and after 6 weeks. Relative to TE group of patients significant differences were observed between VAS and DASH scores at base line and 6 weeks after treatment in both groups [p < 0.001]. While no significant differences were observed relative to VAS and DASH score changes between both groups [p > 0.05]. In PF patients comparison of VAS and FHSQ at base line and 6 weeks after treatment between control group and PRP group showed significant differences for VAS [p = 0.005 and p < 0.001, respectively], and for FHSQ [p = 0.03 and p < 0.001, respectively]. While highly significant difference were observed between both groups regarding VAS and FHSQ changes [p = 0.001]. Local injection of autologous PRP proved to be a promising form of therapy for TE and PF. It is both safe and effective in relieving pain and improving function and superior to local steroids in PF

Ultrasonographic analysis of local steroid injection in plantar fasciitis

The aim of this study was to investigate the value of ultrasonographic examination in the diagnosis of plantar fasciitis and the demonstration of the changes in the plantar fascia following local steroid injection. Twenty patients with clinical diagnosis of plantar fasciitis and 20 normal subjects were studied prospectively. Ultrasound examination was performed using ATL apogee 800 [USA] with 11 MHz linear array transducer. The ultrasonographic examination of plantar fascia was easy and quick to perform. It was suggested that ultrasound should be the screening procedure of choice in heel pain. Local steroid injection proved to be clinically safe and effective in the treatment of plantar fasciitis

Fasceítis eosinofílica con polineuropatía autoinmune y mucinosis papulosa / Eosinophylic fasceitis with autoimmune polyneuropathy and papular mucinosis

La fasceítis eosinofílica es un cuadro clínico de curso benigno que aparece en general tras un esfuerzo físico importante. Se presenta un paciente de 60 años, sexo masculino, con una fasceítis eosinofílica de extenso compromiso cutáneo, polineuropatía y mucinosis papulosa, con buena respuesta al tratamiento combinado con corticoides y cimetidina

Fascitis necrotizante: complicación de colecistectomía laparoscópica / Necrotizing fascitis: laparoscopic cholecystectomy complication

Se da a conocer caso de fascitis necrotizante en colecistectomía laparoscópica. Esta es una complicación aún no descrita en la literatura para este tipo de cirugía en que su diagnóstico oportuno y su tratamiento agresivo evitan una alta mortalidad

Corticotherapie et maladies systemiques

Corticosteroid are an essential mean to overcome systemic disorders. Thirty years ago they changed the prognosis of most of these diseases. Adverse effects are numerous and dangerous, especially infectious diseases and bone disorders. Prednisone is the most used drug. The pulse of methyprednisone is less used. In this study, we discuss some principles of the use of corticosteroid and the problems encountered using corticotherapy in systemic disorders

Fascitis necrotizante: estudio de 15 casos / Necrotizing fascitis: study of 15 cases

Desde enero 1986 a junio 1987 estudiamos 15 pacientes portadores de fascitis necrotizante. Siete hombres y 8 mujeres con edad promedio de 48,7 años (19 y 75 años). Estudiamos la localización, patología asociada, bacteriología, anatomía patológica, tratamiento y evolución. En 33% las lesiones se localizaron en pared abdominal, 44,6% en extremidades inferiores, 6,7% en cuello y tórax. El tiempo promedio entre el inicio de los síntomas y hospitalización fue de 7,4 días (3 y 15 días). Todos los pacientes se trataron con resección amplia y antibióticos parenterales. La asociación más frecuente fue de penicilina, gentamicina y metronidazol. En 12 de los 15 pacientes se obtuvo cultivo de herida operatoria: 11 fueron positivos y 1 negativo. En 3 no se practicó. Cinco pacientes fallecieron (33,3%), 2 antes de las 24 horas post ingreso y 3 antes del 7- día.

Fasciite necrosante / Necrozing fasciitis

A fasciite necrosante deve-se a uma infecçäo polibacteriana incomum e é de prognóstico reservado. Neste trabalho, os autores apresentam dois casos ocorridos no Hospital Universitário de Santa Maria - Santa Maria - RS, no ano de 1988. Discutem a fisiopatologia e o tratamento mais adequado para a patologia. Ambas as infecçöes foram polimicrobianas. O tratamento insituído foi: medidas gerais para o choque séptico, antibioticoterapia de amplo espectro e debridamento cirúrgico radical. Houve sucesso terapêutico em um dos casos, com cura da infecçäo e reconstituiçäo da área debridada com enxertos. A outra paciente foi ao óbito no sétimo dia pós-operatório

Fascitis eosinofilica: presentación de un caso atípico resistente al tratamiento corticosteroide / Eosinophilic fascitis: report of an atypical case resistant to corticosteroid treatment

Se presenta el caso de un paciente masculino de 33 años de edad, mestizo, con el diagnóstico de fascitis eosinofílica atípica que no respondiò satisfactoriamente al tratamiento con corticosteroides. Después de un ciclo de plasmaféresis tuvo una ligera mejoría y con la administración posterior de antiagregantes plaquetarios y colchicina, se logró una notable mejoría de sus manifestaciones clínicas. Estos datos sugieren la utilidad de estos medicamentos en el tratamiento de los casos resistentes a la terapéutica habitual

Fasciite eosinofílica: nova entidade da família das colagenoses / Eosinophilic fasciitis: a new entity of colagenoses family

A fasciite eosinofílica é síndrome de etiologia desconhecida, descrita em 1974, caracterizada por rigidez de pele secundária a fasciite difusa, eosinofilia periférica e hipergamaglobulinemia. Embora similar em muitos aspectos à esclerodermia, apresente características clínicas, laboratoriais e histopatológicas próprias. A resposta terapêutica e a evoluçäo também diferem das da esclerodermia. As características da fasciite eosinofílica, seu diagnóstico diferencial e prognóstico säo discutidos na presente revisäo