DOI: https://doi.org/10.36347/sjmcr.2025.v13i12.027

Pages: 2998-3000

Eosinophilic fasciitis, also known as Shulman’s disease, is a rare scleroderma-like fibrosing disorder characterized by inflammation and thickening of the fascia, often associated with peripheral eosinophilia. Because of its rarity and heterogeneous clinical presentation, EF is frequently misdiagnosed, particularly as systemic sclerosis or other connective tissue diseases. We report the case of a 28-year-old woman with no significant past medical history who presented with a two-week history of painful swelling and progressive induration of the upper and lower limbs, associated with morning stiffness and functional impairment. There was no Raynaud’s phenomenon, no digital ulcers and no visceral involvement. Laboratory investigations revealed marked peripheral eosinophilia at 1,100/mm³, autoimmune serology, including antinuclear and extractable nuclear antigen antibodies, was negative. Magnetic resonance imaging of the affected limbs demonstrated diffuse thickening and enhancement of the superficial and deep fasciae. A full-thickness skin-to-muscle biopsy confirmed the diagnosis by showing dense inflammatory infiltrates rich in eosinophils within the fascia, with associated collagen thickening and fibrosis. The patient was treated with three consecutive daily pulses of intravenous methylprednisolone, then switched to oral prednisone at 1 mg/kg/day with gradual tapering. Clinical response was rapid, with significant improvement in pain, regression of edema and induration, and normalization of eosinophil count and inflammatory markers. This case highlights the importance of considering eosinophilic fasciitis in patients presenting with limb edema and skin induration without Raynaud’s phenomenon, especially in the presence of unexplained eosinophilia. Early recognition and prompt initiation of systemic corticosteroid therapy are crucial to prevent irreversible fibrosis and functional sequelae.