A woman in her 20s was hospitalized for swelling, pain, and induration in the dorsum of her right forearm. A physical examination revealed movement restriction in the right wrist and fingers (Picture 1). Blood tests revealed no eosinophilia, and disease-specific autoantibodies were negative. Magnetic resonance imaging (MRI) revealed thickening of the fascia with a high signal intensity on short T1 inversion recovery (Picture 2). A biopsy of her right forearm showed lymphocyte-predominant inflammatory cell infiltration in the fascia and surrounding adipose tissues without eosinophil infiltration (Picture 3). She was diagnosed with diffuse fasciitis (DF), and glucocorticoid therapy was initiated. Following treatment, her symptoms, range of motion, and MRI findings improved. DF is typically characterized by symmetrical thickening of the skin of the limbs along with eosinophilia in the blood and tissues. However, clinicians should consider DF even in cases like this one with minimal eosinophil involvement and unilateral onset, even though DF is usually recognized as a bilateral disease (1,2).
Picture 1.
Picture 2.
Picture 3.
The authors state that they have no Conflict of Interest (COI).
References
- 1.Pinal-Fernandez I, Selva-O'Callaghan A, Grau JM. Diagnosis and classification of eosinophilic fasciitis. Autoimmun Rev 13: 379-382, 2014. [DOI] [PubMed] [Google Scholar]
- 2.Mazilu D, Boltaşiu Tătaru LA, Mardale DA, et al. Eosinophilic fasciitis: current and remaining challenges. Int J Mol Sci 24: 1982, 2023. [DOI] [PMC free article] [PubMed] [Google Scholar]