title: An unusual case of generalized oedema.
abstract: We present the case of a 66-year-old woman with generalized oedema and pain in the four limbs. Physical examination revealed a diffuse, painful, partly pitting, oedema of forearms, hands, lower legs and feet. There were no signs of synovitis. Laboratory investigation was non relevant, except for mild eosinophilia, which normalized subsequently. Cardiac, nephrological and venous disturbances were excluded. More uncommon disorders, such as eosinophilic fasciitis, early stage of scleroderma and polymyositis were considered. MRI scanning of the right forearm revealed an increased signal intensity in the superficial muscle fibers and thickening of the fascia (figure 1). Subsequently a full thickness biopsy of the musculus flexor digitorum superficialis was performed, revealing an inflammatory infiltration of lymphocytes and eosinophils, localized in the fascia. There was no necrosis of muscle fibers. No signs of scleroderma were found. The biopsy confirmed the diagnosis of eosinophilic fasciitis. Clinical and MRI findings suggested an early stage of disease and the patient was treated with low-dose corticosteroids.
authors.affiliation: Department of Immunology-Rheumatology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, België. stephanieingelbrecht@hotmail.com
authors.forename: S N
authors.initials: SN
authors.lastname: Ingelbrecht
authors.forename: H
authors.initials: H
authors.lastname: Wynants
authors.forename: G
authors.initials: G
authors.lastname: Moorkens
authors.forename: J L
authors.initials: JL
authors.lastname: Gielen
authors.forename: J J
authors.initials: JJ
authors.lastname: Martin
authors.forename: W
authors.initials: W
authors.lastname: Stevens
authors.forename: L S
authors.initials: LS
authors.lastname: De Clerck
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D001707:Biopsy, Needle; D004487:Edema / Q000209:etiology* / Q000503:physiopathology; D004802:Eosinophilia; D005208:Fasciitis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006334:Heart Function Tests; D006801:Humans; D007677:Kidney Function Tests; D008279:Magnetic Resonance Imaging; D035583:Rare Diseases; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones