J Korean Soc Radiol.  2014 Sep;71(3):150-154. 10.3348/jksr.2014.71.3.150.

A Case of Eosinophilic Fasciitis: Imaging Findings from Early Diagnosis to Complete Remission

• Lee JW
• Lee JY

• KMID: 1736482
• DOI: http://doi.org/10.3348/jksr.2014.71.3.150

Abstract

Eosinophilic fasciitis (EF) is a rare disease characterized by symmetric and painful swelling with progressive induration and thickening of the skin and soft tissues of the limbs and trunk. Herein, we report a case of a 31-year-old woman who presented with painful swelling in both lower legs which persisted for 6 days. She underwent ultrasonography (US) in an out-patient department to rule out deep-vein thrombosis. The US did, however, reveal perifascial fluid in the thickened superficial fascia and interstitial fluid in the subcutaneous layer of both lower legs. Magnetic resonance imaging findings were identical to the US and additionally showed no involvement of the muscles or deep fascia. Laboratory data, showing peripheral eosinophilia and a US-guided gun-biopsy showing lymphocytic and eosinophilic infiltration were both indicative of EF. The patient was treated with corticosteroids, resulting in a remarkable improvement in both the lower-leg edema and peripheral eosinophilia. There was no recurrence after 7 years of follow-up.

MeSH Terms

Adrenal Cortex Hormones
Adult
Early Diagnosis*
Edema
Eosinophilia
Eosinophils*
Extracellular Fluid
Extremities
Fascia
Fasciitis*
Female
Follow-Up Studies
Humans
Leg
Magnetic Resonance Imaging
Muscles
Outpatients
Rare Diseases
Recurrence
Skin
Subcutaneous Tissue
Ultrasonography
Venous Thrombosis
Adrenal Cortex Hormones

Figure

• 

  Fig. 1 Eosinophilic fasciitis (EF) in both lower legs of 31-year-old woman. A. Ultrasonography (US) of right-lower leg shows diffuse interstitial fluid in thickened subcutaneous layer (space between arrows) and superficial fascia (arrowheads). There is no intramuscular focal lesion or perifascial fluid in the deep fascia, nor is there any evidence of deep-vein thrombosis (not shown). B, C. Magnetic resonance imaging (MRI) of both lower leg shows interstitial fluid (B, arrows) in subcutaneous layer and superficial fascia on fat-suppressed T2-weighted image (B) and subtle linear enhancement (C, arrows) on fat-suppressed contrast-enhanced T1-weighted image (C). There is no signal change or enhancement within the muscle or deep fascia. D. Photomicrograph (H&E stain, × 100) of fascia-subcutaneous fat junction showing thickened fascia and entrapment of subcutaneous fat by heavy inflammatory cell infiltration. E. High-power photomicrograph (H&E stain, × 400) of fascia showing heavy inflammatory cell infiltration with numerous eosinophils (arrows), lymphocytes and occasional plasma cells. F, G. MRI was obtained after 6 months of corticosteroids treatment. Fat-suppressed T2-weighted image (F) and fat-suppressed contrast-enhanced T1-weighted image (G) showing complete remission. The patient is symptom-free, and the laboratory findings are normal. The arrows show the sites of abnormalities identified in a previous MRI. Note.-D = dermal layer, SC = subcutaneous layer, SF = superficial fascia

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