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.1 Sometimes, it presents associated with various hematological and solid malignancies.1,2

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.3 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 [18F] FDG-PET/CT or ultrasonography, is beginning to be explored.3–5

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. [18F] FDG-PET/CT discarded an occult neoplasia and revealed a diffuse and symmetrical FDG uptake in the fasciae of the legs and thighs (see Fig. 1). 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.

Fig. 1.

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.

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The association of malignancy with certain rheumatic syndromes, including FE was convincingly established.1,2 In those cases in which this possibility arises (explosive onset in advanced age or EF poorly responsive to corticosteroid therapy),6 the realization of a PET–CT could be useful to rule out occult neoplasia and to reinforce the suspected diagnosis.