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Hidden in plain sight: Eosinophilic Fasciitis

  • Author Footnotes
    # 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
    Footnotes
    # 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
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  • Yair Glick
    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
    Search for articles by this author
  • Author Footnotes
    # Both authors have participated n the preparation of the manuscript.
      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 1
      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
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