Coexistence of eosinophilic fasciitis and systemic lupus erythematosus: a case-based review

Eosinophilic fasciitis involves collagenous thickening of the subcutaneous fascia, hypergammaglobulinaemia, and peripheral eosinophilia, manifesting as erythema and oedema of the extremities and trunk. Rarely, it coexists with systemic lupus erythematosus. Eosinophilic fasciitis mimics scleroderma, making early diagnosis crucial. Its association with paraproteinaemia necessitates prompt recognition and treatment. Here, we report the case of a 56-year-old female with systemic lupus erythematosus in remission with methotrexate and hydroxychloroquine who presented with a 1-month history of sudden-onset, progressive skin tightening of the extremities and trunk. There was no history of Raynaud's phenomenon, digital ischaemia, or contractures. Based on histopathology and magnetic resonance imaging findings, eosinophilic fasciitis was diagnosed. She responded significantly to treatment with glucocorticoids and mycophenolate mofetil. This case adds to the evidence of eosinophilic fasciitis in lupus. The diagnosis was based on clinical, imaging, and biopsy findings, emphasizing its link to other connective tissue disorders. Future research should explore larger datasets and innovative treatments.