Diffuse fasciitis with restrictive ventilatory impairment and type 2 respiratory failure: a rare case report

Diffuse fasciitis can be a potential cause of type 2 respiratory failure.Dear Editor, Diffuse fasciitis with or without eosinophilia (DF) is a rare inflammatory condition characterized by marked fibrosis and thickening of the fascia, often with eosinophilic infiltration.DF is typically associated with limb involvement and may lead to joint motion restriction due to sclerotic changes.Although some cases of trunk involvement have been reported, these largely involve superficial fascial changes without significant respiratory compromise.To our knowledge, no prior reports have described diffuse fibrosis of the trapezius and levator scapulae fascia resulting in restricted thoracic expansion and leading to restrictive ventilatory impairment with type 2 respiratory failure.This case uniquely illustrates how deep fascial involvement of respiratory accessory muscles can compromise pulmonary function, expanding the known clinical spectrum of diffuse fasciitis.A 75-year-old woman presented with type 2 respiratory failure and restrictive ventilatory impairment.Over five years, she experienced progressive stiffness and pain in the shoulders, neck, and back, along with a 10 kg weight loss.Mild peripheral eosinophilia (5.2%, 250/L) and restricted mobility of the shoulders and neck were noted during earlier evaluations.Key clinical findings included a height of 145.9 cm, weight of 35.8 kg, blood pressure of 102/47 mmHg, pulse of 67 bpm, temperature of 36.8C, and SpO 2 of 96% on room air.