Eosinophilic Fasciitis in Children: A Case Report

Eosinophilic fasciitis (EF), also known as Shulman's disease, is a rare inflammatory and fibrosing disorder characterized by inflammation and eosinophilic infiltration of the fascia, leading to skin thickening and induration. It typically presents with limb edema progressing to induration and sclerosis and is frequently, but not invariably, associated with peripheral blood eosinophilia. Diagnosis relies on a combination of clinical, laboratory, imaging, and histopathological findings. We report the case of a 16-year-old female patient with a documented history of hypereosinophilic syndrome, moderate persistent asthma, and recurrent cutaneous abscesses, who presented with localized swelling of the left leg approximately one week after minor trauma. Clinical examination revealed a 3-cm fluctuant swelling with local inflammatory signs. Laboratory investigations showed a negative C-reactive protein level and an eosinophil count of 150/mm³, within the laboratory reference range. Soft-tissue ultrasonography demonstrated a subcutaneous collection measuring 24 × 17 mm. The patient received ceftriaxone for seven days without clinical improvement. Direct examination of purulent material showed no microorganisms, and culture was sterile. A deep skin and subcutaneous tissue biopsy revealed moderate fibrosis associated with a dense inflammatory infiltrate rich in eosinophils, with no evidence of malignancy. Based on the clinical and histopathological findings, EF was considered the most likely diagnosis. Systemic corticosteroid therapy was initiated at 1 mg/kg/day, resulting in progressive clinical improvement. This case highlights the diagnostic challenge of localized EF in the absence of peripheral blood eosinophilia and in a patient with a history of recurrent abscesses and hypereosinophilic syndrome. EF should therefore be considered in the differential diagnosis of persistent indurated limb swelling, even when the presentation is localized and mimics an infectious process.