Ultrasound is a useful adjunct in diagnosis of eosinophilic fasciitis

Rheumatology, Nov 2015

Mondal, Sumantro, Goswami, Rudra Prosad, Sinha, Debanjali, Ghosh, Alakendu

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Ultrasound is a useful adjunct in diagnosis of eosinophilic fasciitis

Clinical vignette 0 Department of Rheumatology, Institute of Post Graduate Medical Education and Research , Kolkata , India 1 Sumantro Mondal of hip osteoarthritis. Osteoarthritis Cartilage 2013;21:1530 6. ! The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: www.rheumatology.oxfordjournals.org - Ultrasound is a useful adjunct in diagnosis of eosinophilic fasciitis This 28-year-old male presented with progressive skin tightening and limited joint mobility for 11 months, involving legs up to mid-shin and forearms up to elbows, preceded by painless swelling involving affected regions, sparing fingers and toes. Systemic features were absent. There was peripheral eosinophilia (leucocytes: 11 600/ l, eosinophils 52%, absolute eosinophil count: 6032/ l), raised acute-phase reactants and hypergammaglobulinaemia. Nail-fold capillaroscopy was non-contributory. RP, digital ulcers, dysphagia, reflux and pulmonary arterial hypertension were absent. ANA was positive, and Scl70 and anticentromere antibodies were negative. High-resolution US of legs (Fig. 1A and C) using an 18-MHz linear array transducer showed thickening and altered echointensities afflicting the fascia, alongside deranged echotexture of subcutaneous fat (Fig. 1B is from a healthy person for comparison). MRI of legs (Fig. 1D) showed thickening of fascia, along with increased contrast enhancement of the myofascial plane, corroborating US findings. He was diagnosed as having eosinophilic fasciitis (EF) and put on prednisolone. Apart from histology, MRI is also useful for the diagnosis of EF [ 1 ]. The role of US elastography has been studied in scleroderma, and has demonstrated reduction of strain in the dermis of the forearm due to loss of elasticity [ 2 ]. Here we present a case of EF characterized ultrasonographically with MRI corroboration. Funding: No specific funding was received from any funding bodies in the public, commercial or not-for-profit sectors to carry out the work described in this manuscript. Disclosure statement: The authors have declared no conflicts of interest. (A) and (C) Ultrasonography of legs (A from right leg and C from left leg) showing thickened fascia of the patient (the doubleheaded arrow shows the thickness of the fascia with measurements embedded). (B) Ultrasonography of leg of a normal person (the double-headed arrow shows the normal thickness of fascia with measurements). (D) T1 post contrast MRI image of the patient’s leg, showing thickening and contrast enhancement of the fascial plane (arrows showing thickened fascia). 1 Baumann F , Br u€hlmann P, Andreisek G et al. MRI for diagnosis and monitoring of patients with eosinophilic fasciitis . Am J Roentgenol 2005 ; 184 : 169 74. 2 Iagnocco A , Kaloudi O , Perella C et al. Ultrasound elastography assessment of skin involvement in systemic sclerosis: lights and shadows . J Rheumatol 2010 ; 37 : 1688 91. (...truncated)


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Mondal, Sumantro, Goswami, Rudra Prosad, Sinha, Debanjali, Ghosh, Alakendu. Ultrasound is a useful adjunct in diagnosis of eosinophilic fasciitis, Rheumatology, 2015, pp. 2041, Volume 54, Issue 11, DOI: 10.1093/rheumatology/kev290