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Unusual presentation of eosinophilic fasciitis (EF) with a raised ALT
  1. Thomas Batty1,
  2. Shuja Majeed2,
  3. Christina Wlodek3 and
  4. Harsha Gunawardena2
  1. 1 Department of Medical Education, Brighton and Sussex Medical School, Brighton, UK
  2. 2 Department of Rheumatology, North Bristol NHS Trust, Bristol, UK
  3. 3 Department of Dermatology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  1. Correspondence to Dr Thomas Batty, t.batty{at}


Eosinophilic fasciitis (EF) is a syndrome of unknown aetiology characterised by progressive collagenous thickening of the subcutaneous fascia. Limb oedema can precede the skin thickening and induration classically associated with EF. We describe a case of EF in a 31-year-old woman who presented to her general practitioner with lower limb oedema and stiffness. Blood tests in primary care showed a persistently raised alanine transferase (ALT). No hepatic cause for her raised ALT was found despite investigation. The unusual manner of her presentation led to delay in her referral to the autoimmune connective tissue disease (CTD) clinic. This case illustrates the importance of considering autoimmune CTD such as EF in young patients presenting with limb oedema and raised ALT, as early treatment influences prognosis and functional recovery.

  • rheumatology
  • connective tissue disease
  • liver disease
  • dermatology
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  • Patient consent for publication Obtained.

  • Contributors TB and SM prepared the manuscript and collated information. CW and HG provided clinical input. HG provided senior review and guidance.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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