Background Eosinophilic fascitis is a disorder characterised by the apperance over weeks or months of tender swelling of the arms and legs with inflammation and sclerosis of the deep fascia and subcutis. Long lasting therapy with prednisone is often unsatisfasctory.
Objectives A 40-year-old man suffering from eosinophilic fascitis is reported with skin rush and induration of subcutaneous tissue of the forearm, typical ?groove sign? and contractures of the elbow joints (pict.1,2,3). Skin involvement was accompanied by peripheral eosinophilia (0,33) hypergammaglobulinemia (0,24), an elevated erythrocyte sedimentation rate (28/h) increased concentration of acute phase reactants (C-reactive protein 52 mg/l), alpha-1 acid glycoprotein 1489 mg/l) as well as leukocytosis (14,5 G/l).
Methods The typical treatment with dosis of 20 mg prednisone caused only slight improvement. Moreover the patient has suffered from typical poststeroideal skin changes. Therefore we decided to performe an intravenous pulse methylprednisolone therapy as follows: 3 days-every day 500 mg methylprednisolone as solution in 5% NaCl (two courses with 4 weeks pause). As a continuation the patient has got oraly dosis 7,5 mg prednisone every second day in the morning.
Results After pulse therapy the remission of the symptoms with regression of skin changes and improvement of the acute phase reactants levels (ESR 14/h, CRP 28 mg/l) as well as the normalisation of leukocytosis (10,8 G/L) and eosinophilia (0,03) were observed. After one year observation the patient was still in remission without signs of active inflammatory process and without eosinophilia in blood wet.
Conclusion We recommend in patients with fascitis eosinophilica the intravenous pulse corticosteroids therapy and reduced dosis of prednisone as an alternative to high-dose oral corticosteroids.
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