Case and research letters
Posttraumatic Eosinophilic Fasciitis: Diagnostic Usefulness of Magnetic Resonance Imaging
Fascitis eosinofílica asociada a traumatismo: utilidad diagnóstica de la resonancia magnética
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A. Septo interlobular engrosado en el tejido celular subcutáneo (TCS) con celularidad inflamatoria (hematoxilina-eosina x 40). B. A mayor aumento se observa la presencia de numerosos eosinófilos en el TCS periseptal (hematoxilina-eosina x 400).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Armengot-Carbó, M. Velasco-Pastor, P. Navarro-Conde, E. Gimeno-Carpio" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Armengot-Carbó" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Velasco-Pastor" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "Navarro-Conde" ] 3 => array:2 [ "nombre" => "E." 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Armengot-Carbó, M. Velasco-Pastor, P. Navarro-Conde, E. Gimeno-Carpio" "autores" => array:4 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Armengot-Carbó" "email" => array:1 [ 0 => "miquelarmengot@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Velasco-Pastor" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "P." "apellidos" => "Navarro-Conde" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "E." "apellidos" => "Gimeno-Carpio" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Arnau de Vilanova, Valencia, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Arnau de Vilanova, Valencia, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Fascitis eosinofílica asociada a traumatismo: utilidad diagnóstica de la resonancia magnética" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 535 "Ancho" => 952 "Tamanyo" => 48988 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Magnetic resonance imaging of the lower limbs. Axial short TI inversion recovery images. The muscle fascia is thickened and shows an increased signal intensity (arrows).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Eosinophilic fasciitis is a rare scleroderma-like disorder that mainly affects the muscle fascia. It usually occurs in adults between the ages of 20 years and 70 years.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 54-year-old patient with no past medical history of interest, who came to the clinic because of a rapidly progressive induration of the limbs, abdomen and lower back 1 month after an accidental fall (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). The condition had started as edema and erythema of the lower limbs, spreading to other areas, with the subsequent appearance of induration. The diagnoses considered were eosinophilic fasciitis, scleroderma, scleredema, and scleromyxedema. The patient did not present Raynaud phenomenon, dysphagia, or sclerodactyly.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Complete blood count showed a raised white cell count with marked eosinophilia (3.10×10<span class="elsevierStyleSup">3</span>/μL, 22%). Other laboratory tests, including the erythrocyte sedimentation rate, antinuclear antibodies and rheumatoid factor, were normal or negative.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Histopathology of a deep biopsy of the forearm showed interlobular septal thickening and an inflammatory infiltrate with numerous eosinophils affecting the septa and adjacent subcutaneous tissue, which was moderately edematous (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). There were no changes of note in the epidermis and dermis; the muscle fascia could not be assessed. Magnetic resonance imaging (MRI) of the lower limbs showed thickening of the muscle fascia with signal hyperintensity on short TI inversion recovery sequences, indicating inflammation (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The patient was diagnosed with eosinophilic fasciitis on the basis of the peripheral eosinophilia, histological findings, and the fasciitis observed on MRI. Treatment was initiated with oral prednisone at a dose of 1<span class="elsevierStyleHsp" style=""></span>mg/kg/d and hydroxychloroquine, with the subsequent addition of methotrexate to reduce the necessary dose of corticosteroids. The clinical course was favorable, with blood parameters returning to normal at 2 months and disappearance of the induration after 12 months of treatment (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B).</p><p id="par0030" class="elsevierStylePara elsevierViewall">Eosinophilic fasciitis was first described by Shulman in 1974 in patients with diffuse fasciitis and peripheral eosinophilia; it is clinically characterized by induration of the subcutaneous tissues, predominately affecting the limbs, preceded by an initial stage involving erythema and edema.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Peripheral eosinophilia is a typical finding and is present in up to 80% of cases.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In general, there is no visceral involvement, Raynaud phenomenon, or sclerodactyly.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Its appearance has been associated with various triggers such as extreme physical exercise, insect bites, <span class="elsevierStyleItalic">Borrelia</span> infection, and the use of certain drugs such as statins. Toxic oil syndrome caused by adulterated rapeseed oil has also been associated with the disorder.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a> To date, only 5 cases have been reported following an uncomplicated trauma.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,5,6</span></a> In our case, the close temporal association with the accidental fall and the absence of other predisposing factors suggests that this was the trigger. A similar case has been described in the literature, in which eosinophilic fasciitis developed 1 week after a fall.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> It has been suggested that in these patients the trauma could reveal antigenic properties of the fascia and subcutis, thus initiating the process.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>If eosinophilic fasciitis is suspected, a full-thickness biopsy is needed to determine whether the muscle fascia is affected.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Histology shows fibrous thickening of the fascia with a diffuse lymphoplasmocytic inflammatory infiltrate and varying numbers of eosinophils. These changes often extend locally into the interlobular septa of the adjacent adipose tissue and into the muscle layers.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The role of MRI has become of increasing importance in the diagnosis of eosinophilic fasciitis and in its follow-up.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7–10</span></a> Characteristic findings include thickening and increased signal intensity of the muscle fascia on T2-weighted and short T1 inversion recovery sequences, with enhancement following administration of contrast material on T1-weighted sequences; these changes correspond to the degree of microscopic inflammation.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,10</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">However, in some patients the biopsy is suboptimal or cannot be performed, and thus the findings from MRI are used to identify involvement of the fascia and reach a diagnosis.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,9</span></a> Our case provides a novel example of eosinophilic fasciitis that was diagnosed by MRI after biopsy proved inconclusive.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Therefore, although biopsy remains the diagnostic procedure of choice, MRI can be very useful to confirm inflammation of the muscle fascia in cases in which this cannot be assessed on the biopsy or when the findings are inconclusive.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,9</span></a> In addition, by confirming that the process mainly affects the fascia, MRI helps to distinguish eosinophilic fasciitis from other disorders such as polymyositis or scleroderma.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Attention has also been drawn to its usefulness when selecting the optimal area from which to take a biopsy, and to identify improvement in fascial inflammation after starting treatment.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,10</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">In conclusion, the case presented demonstrates the usefulness of MRI in establishing a diagnosis of eosinophilic fasciitis in patients when histopathological findings are inconclusive. In addition, a history of an accidental fall in the absence of other precipitating factors supports the role of trauma as a possible trigger of the disease.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Armengot-Carbó M, et al. Fascitis eosinofílica asociada a traumatismo: utilidad diagnóstica de la resonancia magnética. Actas Dermosifiliogr.2011;102:641-2.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 702 "Ancho" => 935 "Tamanyo" => 89570 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Photograph of the forearm. A, Pinching the skin is difficult due to induration. B, There is a decrease in induration after 12 months of treatment.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 641 "Ancho" => 1733 "Tamanyo" => 275952 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histopathology image of biopsy sample from the forearm. A, Interlobular septal thickening in the subcutaneous cellular tissue with inflammatory cells (hematoxylin-eosin, original magnification ×40). B, Higher magnification reveals the presence of numerous eosinophils in the subcutaneous cellular tissue adjacent to the septa (hematoxylin-eosin, original magnification ×400).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 535 "Ancho" => 952 "Tamanyo" => 48988 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Magnetic resonance imaging of the lower limbs. Axial short TI inversion recovery images. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 8 | 12 | 20 |
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| 2023 Enero | 94 | 25 | 119 |
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| 2021 Octubre | 110 | 43 | 153 |
| 2021 Septiembre | 98 | 38 | 136 |
| 2021 Agosto | 118 | 32 | 150 |
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| 2020 Octubre | 37 | 8 | 45 |
| 2020 Septiembre | 36 | 14 | 50 |
| 2020 Agosto | 31 | 24 | 55 |
| 2020 Julio | 27 | 13 | 40 |
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| 2020 Mayo | 26 | 15 | 41 |
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| 2020 Marzo | 27 | 22 | 49 |
| 2020 Febrero | 3 | 3 | 6 |
| 2020 Enero | 0 | 7 | 7 |
| 2019 Diciembre | 4 | 1 | 5 |
| 2019 Noviembre | 0 | 3 | 3 |
| 2019 Octubre | 1 | 3 | 4 |
| 2019 Septiembre | 10 | 2 | 12 |
| 2019 Agosto | 0 | 1 | 1 |
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| 2019 Febrero | 6 | 10 | 16 |
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| 2018 Diciembre | 0 | 9 | 9 |
| 2018 Noviembre | 1 | 3 | 4 |
| 2018 Octubre | 2 | 0 | 2 |
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| 2018 Agosto | 0 | 13 | 13 |
| 2018 Julio | 0 | 8 | 8 |
| 2018 Mayo | 0 | 7 | 7 |
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| 2018 Marzo | 13 | 4 | 17 |
| 2018 Febrero | 76 | 2 | 78 |
| 2018 Enero | 92 | 7 | 99 |
| 2017 Diciembre | 119 | 9 | 128 |
| 2017 Noviembre | 76 | 4 | 80 |
| 2017 Octubre | 82 | 6 | 88 |
| 2017 Septiembre | 86 | 6 | 92 |
| 2017 Agosto | 139 | 7 | 146 |
| 2017 Julio | 115 | 6 | 121 |
| 2017 Junio | 134 | 21 | 155 |
| 2017 Mayo | 119 | 11 | 130 |
| 2017 Abril | 105 | 10 | 115 |
| 2017 Marzo | 96 | 23 | 119 |
| 2017 Febrero | 68 | 23 | 91 |
| 2017 Enero | 59 | 16 | 75 |
| 2016 Diciembre | 80 | 22 | 102 |
| 2016 Noviembre | 133 | 9 | 142 |
| 2016 Octubre | 147 | 17 | 164 |
| 2016 Septiembre | 216 | 9 | 225 |
| 2016 Agosto | 115 | 14 | 129 |
| 2016 Julio | 61 | 9 | 70 |
| 2016 Junio | 8 | 10 | 18 |
| 2016 Mayo | 10 | 8 | 18 |
| 2016 Abril | 5 | 25 | 30 |
| 2016 Marzo | 9 | 2 | 11 |
| 2016 Febrero | 4 | 2 | 6 |
| 2016 Enero | 9 | 8 | 17 |
| 2015 Diciembre | 7 | 9 | 16 |
| 2015 Noviembre | 27 | 9 | 36 |
| 2015 Octubre | 8 | 6 | 14 |
| 2015 Septiembre | 8 | 1 | 9 |
| 2015 Agosto | 9 | 1 | 10 |
| 2015 Julio | 139 | 7 | 146 |
| 2015 Junio | 97 | 8 | 105 |
| 2015 Mayo | 106 | 15 | 121 |
| 2015 Abril | 90 | 9 | 99 |
| 2015 Marzo | 71 | 9 | 80 |
| 2015 Febrero | 88 | 4 | 92 |
| 2015 Enero | 69 | 13 | 82 |
| 2014 Diciembre | 67 | 11 | 78 |
| 2014 Noviembre | 51 | 9 | 60 |
| 2014 Octubre | 97 | 16 | 113 |
| 2014 Septiembre | 55 | 7 | 62 |
| 2014 Agosto | 83 | 8 | 91 |
| 2014 Julio | 113 | 13 | 126 |
| 2014 Junio | 98 | 14 | 112 |
| 2014 Mayo | 125 | 18 | 143 |
| 2014 Abril | 98 | 11 | 109 |
| 2014 Marzo | 120 | 18 | 138 |
| 2014 Febrero | 93 | 17 | 110 |
| 2014 Enero | 101 | 12 | 113 |
| 2013 Diciembre | 58 | 13 | 71 |
| 2013 Noviembre | 62 | 15 | 77 |
| 2013 Octubre | 75 | 16 | 91 |
| 2013 Septiembre | 59 | 6 | 65 |
| 2013 Agosto | 32 | 11 | 43 |
| 2013 Julio | 15 | 20 | 35 |
| 2013 Junio | 10 | 13 | 23 |
| 2013 Mayo | 18 | 6 | 24 |
| 2013 Abril | 22 | 16 | 38 |
| 2013 Marzo | 18 | 12 | 30 |
| 2013 Febrero | 28 | 5 | 33 |
| 2013 Enero | 25 | 7 | 32 |
| 2012 Diciembre | 12 | 4 | 16 |
| 2012 Octubre | 1 | 3 | 4 |
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