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
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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)