Eosinophilic Fasciitis

Eosinophilic fasciitis (Shulman disease) is clinically characterized by stiffness, swelling, and pain in the extremities that typically presents suddenly after strenuous activity and responds to steroid therapy. Other causes of eosinophilic fasciitis include exposure to simvastatin, trichloroethylene, and L-tryptophan (contaminated and otherwise).

Patients may have peripheral eosinophilia, hypergammaglobulinemia, elevated sedimentation rate, and sclerodermalike skin findings primarily of the extremities. Involvement of the trunk has also been reported.

MRI in patients with active eosinophilic fasciitis reveals fascial thickening, increased fluid signal within the fascia, and fascial enhancement.

References

• Baumann F, Brühlmann P, Andreisek G, Michel BA, Marincek B, Weishaupt D. MRI for diagnosis and monitoring of patients with eosinophilic fasciitis. AJR Am J Roentgenol. 2005 Jan;184(1):169-74.
• Blauvelt A, Falanga V. Idiopathic and L-tryptophan-associated eosinophilic fasciitis before and after L-tryptophan contamination. Arch Dermatol. 1991 Aug;127(8):1159-66.
• Hamilton ME. Eosinophilic fasciitis associated with L-tryptophan ingestion. Ann Rheum Dis. 1991 Jan;50(1):55-6.
• Moulton SJ, Kransdorf MJ, Ginsburg WW, Abril A, Persellin S. Eosinophilic fasciitis: spectrum of MRI findings. AJR Am J Roentgenol. 2005 Mar;184(3):975-8.