A case of eosinophilic fasciitis

We encountered a case of eosinophilic fasciitis in a patient who subsequently was successfully treated with systemic steroid therapy. A 29-year-old man had played futsal frequently since March 2010. He had noted progressive swelling of his upper and lower limbs since August 2010, and visited us in September 2010. On physical examination, his lower extremities were markedly swollen with joint stiffness, and the skin was hard. He showed neither Raynaud's phenomenon nor a specific pattern in capillary microscopy. Laboratory results showed increased blood eosinophils and serum aldolase. Short T1 inversion recovery magnetic resonance image showed fascial enhancement consistent with active inflammation. Histological examination of a biopsy taken from the left lower limb revealed dermal fibrosis and interlobular fibrous septum of subcutis with mild infiltration of lymphocytes and eosinophils. The clinical and pathological findings were consistent with those of eosinophilic fasciitis. He was started on prednisolone (20mg daily), and the edematous changes and skin induration of the lower extremities gradually improved, and are now completely recovered and show no symptoms. It is generally believed that fascial fibrosis is basically irreversible once it is completed, and some patients are left with flexion contractures and suffer from carpal and tarsal tunnel syndrome. Thus, it is desirable to begin treatment as soon as possible. In our patient, we suggest that early diagnosis and intervention were the key to successful treatment.