Fiberoptic laryngoscopy as a guide to tracheal extubation in acute epiglottitis

Abstract

atrophic skin changes? There are no diagnostic laboratory features of eosinophilic fasciitis, although peripheral blood eosinophilia is usually present, and most patients have modest elevations of the serum immunoglobulin concentrations and erythrocyte sedimentation rates. 7-8 Histologically, eosinophilic fasciitis is characterized by inflammation and thickening of the collagen bundles of the deep fascia, with some extension into the muscle and subcutaneous tissue. Eosinophils are rarely prominent in the tissue infiltrate; the major infiltrative cells are lymphocytes and plasma cells. 7~9 However, biopsy during the acute stage of eosinophilic fasciitis may show prominent eosinophilic infiltrate of the dermis and subcutis, 9 thus blurring the histologic distinction between it and eosinophilie eellulitis. Signs and symptoms in our patient would most closely fit the syndrome of eosinophilic cellulitis. Exact categorization of difficult, however, because eosinophilic cellulitis and eosinophilic fasciitis share a number of features in common. Further characterization will await precise definition of the cause(s) of these two conditions. REFERENCES 1. Wells GC: Recurrent granulomatous dermatitis with eosinophilia. Trans St Johns Hosp Dermatol Soc 57:46, 1971. 2. Shulman LE: Diffuse fasciitis with hypergammaglobulinemia and eosinophilia: A new syndrome? (abst). J Rheumatol (SuppI) 1:82, 1974. 3. WeIIs GC, Smith NP: Eosinophilic ceIlulitis. Br J Dermatol 100:10t, 1979. 4. Nielsen T, Schmidt H, Sogaard H: Eosinophilic cellulitis (Well's syndrome) in a child. Arch Dermatol 117:427, 1981. 5. Spigel GT, Winkelmann RK: Well's syndrome: Recurrent granulomatous dermatitis with eosinophilia. Arch Dermatol 115:611, 1979. 6. Rosenthal J, Benson MD: Diffuse fasciitis and eosinophilia with symmetric polyarthritis. Ann Intern Med 92:507, 1980. 7. Michet C J, Doyle JA, Ginsburg WW: Eosinophilic fasciitis: Report of 15 cases. Mayo Clin Proc 56:27, I981. 8. Moutsopoulos HM, Webber BL, Pavlidis NA, Fostiropoulos G, Goules D, Shulman LE: Diffuse fasciitis with eosinophilia: A clinicopathologic study. Am J Med 68:701, 1980. 9. Barnes L, Rodman GP, Medsger TA, Short D: Eosinophilic fasciitis: A pathologic study of twenty cases. Am J Pathol 96:493, 1979.