Eosinophilic Fasciitis in a 68-Year-Old Female

Eosinophilic fasciitis (EF) is an uncommon disorder of unknown etiology and poorly understood pathogenesis. In this report, we present a case of a 68-year-old female presented with a rapidly progressing skin tightening condition in her extremities associated with eosinophilia. Four months prior, the patient's initial complaint was skin sensitivity in the legs and forearms. Over time, this led to severe skin tightening, edema, and decreased range of motion. Clinical examination showed tightening of the skin over the anterior forearms, posterior knees, and calves without sclerodactyly or Raynaud's phenomenon. Laboratory investigations showed eosinophilia, elevated antinuclear antibody titer, and negative rheumatoid factor. This presentation raised suspicion of EF, and biopsy results showed scattered lymphocytic infiltrate involving associated fibrous tissue and perivascular lymphocytic inflammation that involved vessel walls. She was treated with low-dose steroids due to her diabetes but the stiffness continued. She was started with immunomodulators methotrexate, which showed improvement in symptoms, including softening in her arm tissues.