Eosinophilic fasciitis in the context of autoimmune skin diseases: a case report

Eosinophilic fasciitis (EF) is a rare autoimmune disorder affecting the connective tissue. It is characterized by painful inflammation and fibrosis, leading to sclerosis of fascia concerning limbs. Diagnosis is mostly based on clinical findings and confirmed by histopathological examination. Its rare occurrence and non-obvious course of this disease, mimicking more common syndromes, often causes diagnostic problems. During the diagnostic process, a number of diseases must be excluded: systemic scleroderma (SS), nephrogenic systemic fibrosis, eosinophilia-myalgia syndrome, or Churg-Strauss syndrome (EGPA). The following case report features a 67-year-old female and identifies the characteristic clinical and laboratory features that allow the differentiation of EF from systemic sclerosis and other autoimmune skin diseases, which is useful in everyday clinical practice. The patient complained of increasing swelling of the lower limbs, forearms, and induration in the subcutaneous tissue without involvement of the hands and feet. Based on the biopsy and additional tests, she was diagnosed with EF and treated primarily with oral glucocorticoids (GC). Due to the present side effects of steroid therapy, the decision was made to reduce the doses of GSs with the introduction of methotrexate (MTX). This modification proved successful, and after 23 weeks of treatment, remission of symptoms was observed without further progression of the disease.