Ultrasound is a useful adjunct in diagnosis of eosinophilic fasciitis: Fig. 1

Abstract

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/μl, eosinophils 52%, absolute eosinophil count: 6032/μl), 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.