Subject(s)
Eosinophilia/chemically induced , Fasciitis/chemically induced , Immunologic Factors/adverse effects , Natalizumab/adverse effects , Eosinophilia/diagnostic imaging , Eosinophilia/pathology , Fasciitis/diagnostic imaging , Fasciitis/pathology , Humans , Male , Middle Aged , Multiple Sclerosis/drug therapy , UltrasonographyABSTRACT
Eosinophilic fasciitis is an uncommon connective tissue disease that may mimic and overlap with other sclerosing disorders such as morphea and lichen sclerosus. Herein, we report four patients (two men and two women, aged 16-64 yeas) with eosinophilic fasciitis. There was overlap with both morphea and lichen sclerosus in 2 patients and with morphoea alone in 1 patient. Magnetic resonance imaging (MRI) was used for diagnosis in three patients and for assessing treatment response in one patient. Eosinophilic fasciitis may co-exist with morhoea and lichen sclerosus. In view of the overlapping clinical and histopathological features of these disorders, MRI may be helful in delineating the conditions by detecting involvement of fascia.
Subject(s)
Adrenal Cortex Hormones/administration & dosage , Echo-Planar Imaging/methods , Eosinophilia/pathology , Fasciitis/pathology , Lichen Sclerosus et Atrophicus/pathology , Scleroderma, Localized/pathology , Adolescent , Biopsy, Needle , Diagnosis, Differential , Eosinophilia/diagnosis , Eosinophilia/drug therapy , Fasciitis/diagnosis , Fasciitis/drug therapy , Female , Follow-Up Studies , Humans , Immunohistochemistry , Lichen Sclerosus et Atrophicus/diagnosis , Lichen Sclerosus et Atrophicus/drug therapy , Male , Middle Aged , PUVA Therapy/methods , Risk Assessment , Sampling Studies , Scleroderma, Localized/diagnosis , Scleroderma, Localized/drug therapy , Treatment OutcomeABSTRACT
The histologic finding of variably acid-fast coccoid forms in all the available biopsy material (skin, lymph nodes, and lung) from a case of coexisting scleroderma-like cutaneous disease (hypodermitis sclerodermiformis) and systemic sarcoidosis is reported. The morphologic size, shape, and staining characteristics of these microbes, along with the presence of the lung of 'large bodies', suggest that these microbes are cell wall deficient L forms of mycobacteria. Culture of the skin of the scleroderma-like lesion yielded Staphylococcus epidermidis, and the relationship of this isolate to the histologic findings of bacteria is discussed, as well as the possible pathogenic role played by L forms of mycobacteria in collagen disease and systemic sarcoidosis.