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# Both authors have participated n the preparation of the manuscript.
Ami Schattner
Correspondence
Correspondence: Ami Schattner, MD Professor of Medicine, The Faculty of Medicine, Hebrew University and Hadassah, Jerusalem, Israel, Phone 972 8 939 0330
# Both authors have participated n the preparation of the manuscript.
Affiliations
Chief Consultant, Meuhedet HMO, Rehovot and The Faculty of Medicine, Hebrew University and Hadassah Medical School, Jerusalem (AS), and Consultant, Department of Imaging, Laniado Hospital, Sanz Medical Center, Netanya (YG), Israel
Chief Consultant, Meuhedet HMO, Rehovot and The Faculty of Medicine, Hebrew University and Hadassah Medical School, Jerusalem (AS), and Consultant, Department of Imaging, Laniado Hospital, Sanz Medical Center, Netanya (YG), Israel
A 66-year-old woman complained of gradual swelling and hardening of the skin of all
limbs over 2 months, which started distally in the legs and progressed upwards, symmetrically,
associated with difficulties in function and a weight gain of 10%. Examination was
notable for diffuse marked limb edema (mostly non-pitting) and hardening of the skin
with prominent peau d'orange appearance of the cubital fossa (Fig. 1A, B). The examination was otherwise normal. Her past history included obesity and
diabetes and dyslipidemia treated with empagliflozin and atorvastatin. When blood
count revealed eosinophilia (absolute count 3270, normal hemoglobin and platelets)
she was admitted to a teaching hospital.
Figure 1A. ‘Peau d'orange’ appearance of the patient's cubital fossa. Note proximal and distal
swelling (and hardening) of the upper limb. B. Swelling and hardening of the skin
of the lower legs, with both pitting and non-pitting edema
