Eosinophilic fasciitis — SCE Rheumatology MCQ

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ModerateConnective Tissue DiseasesEosinophilic fasciitisSCE Rheumatology

A 44-year-old man develops painful swelling and woody induration of both forearms after a new intensive exercise programme. Fingers are spared and there is a groove sign along superficial veins. Eosinophils are 1.8 × 10⁹/L and ANA is negative. He has no Raynaud's phenomenon. What is the most likely diagnosis?

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Correct answer: E — Eosinophilic fasciitis

Explanation lettering: D = shown as A · C = shown as B · B = shown as C · A = shown as D

Eosinophilic fasciitis is best because symmetrical limb induration with groove sign, eosinophilia and finger/Raynaud sparing suggests eosinophilic fasciitis. A is less suitable because morphea profunda may mimic but eosinophilia and exercise-triggered limb fasciitis favour eosinophilic fasciitis; B is less suitable because diffuse systemic sclerosis usually involves fingers with Raynaud's and nailfold abnormalities; C is less suitable because scleredema typically affects neck and upper back in diabetes or post-infection; D is less suitable because dermatomyositis causes rash and muscle weakness rather than fascial groove sign. Clinical pearl: finger sparing is a useful discriminator from systemic sclerosis.

Reference: Oxford Textbook of Rheumatology; BSR systemic sclerosis guideline 2024