Eosinophilic fasciitis. Ultrastructural study of an early biopsied case

A 55-year-old women with eosinophilic fasciitis was biopsied 8 weeks after the onset of her illness. Under the electron microscope the changes were almost exclusively located in the fascia with many active fibroblasts, accumulation of protocollagen fibrils (10-50 A diameter), elastic fibre remodelling and numerous degranulating mast cells. The inflammatory infiltrate was dense and mostly composed of lymphocytes and plasma cells, with 16% eosinophils. The connective tissue changes may be part of a healing process following microinjury of the fascia. However, large numbers of lymphocytes and plasma cells are unusual in the healing process and are more common in the cellular reaction of morphea. Nevertheless, the absence of macrophages in subcutaneous fat, together with large number of eosinophils in the fascia may be considered to be distinctive features of eosinophilic fasciitis.