Images in Clinical Rheumatology
[18F] FDG PET/CT may be a useful adjunct in diagnosis of eosinophilic fasciitis
[18F] FDG PET/CT puede ser un complemento útil en el diagnóstico de fasciitis eosinofílica
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(A) Longitudinal view of the distal ulna, with grey-scale grade 2 synovitis of the distal radio-ulnar joint (asterisk). (B) Transverse view of the distal radio-ulnar joint, with an intrahyaline hyperechoic band parallel to the surface of the distal ulnar cartilage (arrows). (C) Several hyperechoic spots with a “punctate pattern” of the triangular fibrocartilage complex (arrow heads). L – lunate; R – radium; U – ulna.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Nikita Khmelinskii, Joaquim Polido-Pereira" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Nikita" "apellidos" => "Khmelinskii" ] 1 => array:2 [ "nombre" => "Joaquim" "apellidos" => "Polido-Pereira" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574319301558?idApp=UINPBA00004M" "url" => "/21735743/0000001500000006/v1_201911250632/S2173574319301558/v1_201911250632/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Clinical Rheumatology</span>" "titulo" => "[<span class="elsevierStyleSup">18</span>F] FDG PET/CT may be a useful adjunct in diagnosis of eosinophilic fasciitis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e142" "paginaFinal" => "e143" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Javier Narváez, Pablo Juarez, Isabel Morales Ivorra, Laura Rodriguez Bel, Jesus Rodriguez Moreno, Montserrat Romera" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Javier" "apellidos" => "Narváez" "email" => array:1 [ 0 => "fjnarvaez@bellvitgehospital.cat" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Pablo" "apellidos" => "Juarez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Isabel" "apellidos" => "Morales Ivorra" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Laura" "apellidos" => "Rodriguez Bel" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Jesus" "apellidos" => "Rodriguez Moreno" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Montserrat" "apellidos" => "Romera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Rheumatology, Hospital Universitario de Bellvitge-IDIBELL, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "PET Unit, Institut de Diagnòstic per la Imatge (IDI), Hospital Universitario de Bellvitge-IDIBELL, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "[<span class="elsevierStyleSup">18</span>F] FDG PET/CT puede ser un complemento útil en el diagnóstico de fasciitis eosinofílica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3275 "Ancho" => 2500 "Tamanyo" => 403891 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">FDG-PET/CT revealed a diffuse and symmetrical FDG uptake in the fasciae of the lower limbs, clearly illustrating the anatomical involvement of the disease.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Eosinophilic fasciitis (EF) is a rare connective tissue disease characterized by symmetrical and painful swelling with a progressive induration and thickening of the skin and soft tissues.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Sometimes, it presents associated with various hematological and solid malignancies.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The diagnosis of EF is confirmed by histopathological examination demonstrating a thickened fascia with an inflammatory infiltration, mostly composed of lymphocytes and eosinophils. A peripheral eosinophilia is frequently present (60–90%) but is not mandatory for the EF diagnosis. At the onset, apart from histology, magnetic resonance imaging (MRI) is currently considered the ideal imaging modality for diagnosis EF.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> This technique is also useful for determining the optimal location of muscle biopsy and for follow-up purposes. The ussefulness for the diagnosis of other imaging techniques, such as [<span class="elsevierStyleSup">18</span>F] FDG-PET/CT or ultrasonography, is beginning to be explored.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3–5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">We report a case of EF in a 72-year-old woman who presented with a 1-month history of fatigue, weight loss, and rapidly progressive induration of her lower limbs without any skin manifestations. Laboratory tests showed an elevated erythrocyte sedimentation rate and hypereosinophilia. [<span class="elsevierStyleSup">18</span>F] FDG-PET/CT discarded an occult neoplasia and revealed a diffuse and symmetrical FDG uptake in the fasciae of the legs and thighs (see <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). A biopsy specimen from the right leg, in which the FDG uptake was the strongest, showed marked eosinophilic infiltration in the fascia, but not in the muscle. The clinical suspicion of EF was confirmed and the patient was treated successfully with corticosteroids and methotrexate.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The association of malignancy with certain rheumatic syndromes, including FE was convincingly established.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,2</span></a> In those cases in which this possibility arises (explosive onset in advanced age or EF poorly responsive to corticosteroid therapy),<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> the realization of a PET–CT could be useful to rule out occult neoplasia and to reinforce the suspected diagnosis.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethics approval</span><p id="par0025" class="elsevierStylePara elsevierViewall">In accordance with the guidelines of our institutional ethics committee, formal approval for this study was not required. The local ethics committee agreed that the findings in this report were based on normal clinical practice and were therefore suitable for dissemination. Informed consent of the patient was obtained, and her clinical record and information were anonymized. This study was conducted in accordance with the principles of the Declaration of Helsinki and the International Conference for Harmonization.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Data availability statement</span><p id="par0030" class="elsevierStylePara elsevierViewall">All relevant data are within the paper.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Ethical disclosures</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Protection of human and animal subjects</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Confidentiality of data</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Right to privacy and informed consent</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Funding</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors have no support or funding to report.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflict of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors have declared that no competing interests exists.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Ethics approval" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Data availability statement" ] 2 => array:3 [ "identificador" => "sec0015" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Right to privacy and informed consent" ] ] ] 3 => array:2 [ "identificador" => "sec0035" "titulo" => "Funding" ] 4 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflict of interest" ] 5 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-07-20" "fechaAceptado" => "2017-09-07" "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3275 "Ancho" => 2500 "Tamanyo" => 403891 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">FDG-PET/CT revealed a diffuse and symmetrical FDG uptake in the fasciae of the lower limbs, clearly illustrating the anatomical involvement of the disease.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis and classification of eosinophilic fasciitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "I. Pinal Fernández" 1 => "A. Selva-O’Callaghan" 2 => "J.M. Grau" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.autrev.2014.01.019" "Revista" => array:6 [ "tituloSerie" => "Autoimmun Rev" "fecha" => "2014" "volumen" => "13" "paginaInicial" => "379" "paginaFinal" => "382" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24424187" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eosinophilic fasciitis as a paraneoplastic syndrome, a case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H. Haddad" 1 => "S. Sundaram" 2 => "C. Magro" 3 => "U. 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Daiki Nakagomi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2169/internalmedicine.55.6937" "Revista" => array:6 [ "tituloSerie" => "Intern Med" "fecha" => "2016" "volumen" => "55" "paginaInicial" => "2321" "paginaFinal" => "2322" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27523020" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rheumatic syndromes: clues to occult neoplasia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.E. Naschitz" 1 => "I. Rosner" 2 => "M. 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