Abstract
Eosinophilic fasciitis is a rare disorder of unknown etiology and poorly understood pathogenesis. It may be triggered by excessive exercise, physical factors such as radiation therapy, exposure to certain medications, infections, the initiation of hemodialysis and some other medical conditions. Skin modifications appear with collagenous thickening of the subcutaneous fascia with typical aspect of “peau d’orange” and the “groove sign”. Arthritis, myalgia, myositis, neuropathies may occur. The majority of patients have peripheral blood eosinophilia. The diagnosis is confirmed with a full thickness incisional biopsy of skin and subcutaneous tissue down to the muscle surface and fascia. Systemic glucocorticoids are the mainstay of treatment, but some patients require additional immunosuppressive therapy. The long-term prognosis of this disease is unknown and in some cases the disease may releapse. We describe two patients with eosinophilic fasciitis, their evolution and complications, associating other pathologies: morphea and antiphospholipid syndrome, making the diagnosis and the treatment more challenging.
Highlights
Eosinophilic fasciitis is a rare disorder of unknown etiology and poorly understood pathogenesis
We considered: methotrexate toxicity, but at the moment of the evaluation no other significant abnormality was found on hemogram, haematological disorder, since this is found frequent in association with eosinophilic fasciitis, but peripheral smear was without any sign of this pathological condition, no lymph nodes on CT, consume in the thrombotic state, the most probable hypothesis, since the patient was positive for lupus anticoagulant
Second case is about a patient diagnosed with eosinophilic fasciitis at the beginning of the 2020, with no proven solid or hematologic neoplasia at the moment of diagnosis and no response at initial treatment represented by systemic glucocorticoids [29,43]
Summary
Eosinophilic fasciitis is a rare disorder of unknown etiology and poorly understood pathogenesis. After 2 years of immunosuppressive therapy, the patient had a favorable evolution with normal inflammatory biomarkers and normal range of the eosinophil count. She declared that skin induration was the most prom-. The patient declared that she continued her immunosuppressive treatment with methotrexate 20 mg/week, but new skin changes appeared. She sent us some pictures (see figures 11-12). The other lesions, progressed with deep adherent bands, lesions similar to “groove sing” but they seem to be wider Her laboratory results revealed inflammation with CRP value – 3 times the upper limit of normal value and eosinophilia (10.5%, 851/mm).
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