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Eosinophilic fasciitis (Shulman disease) with clinical, imaging and pathological correlation
  1. Ana Primitivo1,
  2. Nathalie Madeira2,
  3. Dolores Lopez3 and
  4. Diana Afonso4
  1. 1Radiology, Hospital Beatriz Ângelo, Loures, Portugal
  2. 2Reumatology, Instituto Português de Reumatologia, Lisboa, Lisboa, Portugal
  3. 3Anatomical Pathology, Centro Hospitalar Lisboa Norte EPE, Lisboa, Lisboa, Portugal
  4. 4Department of Radiology, Hospital da Luz, Lisboa, Lisboa, Portugal
  1. Correspondence to Dr Ana Primitivo; anaprimitivo{at}


Eosinophilic fasciitis (EF) is a rare subacute fibrosing disorder of unknown aetiology, characterised by thickening of the muscular fascia and subcutaneous tissue, leading to swelling of limbs and trunk and sparing fingers and toes. Eosinophilic infiltration and degranulation may prompt tissue damage and consequent fibrosis due to the accumulation of collagen and extracellular matrix proteins. MRI is the best imaging modality for diagnosis, depicting fascial thickening and enhancement. MRI may also have a significant role in excluding alternative diagnosis and guiding the skin–muscle biopsy.

We report a case of EF with clinical and pathological correlation, highlighting the diagnostic value of MRI for early diagnosis and further treatment.

  • musculoskeletal and joint disorders
  • skin
  • rheumatology
  • radiology

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  • Contributors AP and NM reviewed the literature and wrote the first draft. DLP provided the histological diagnosis and the image used in this section. DA helped in the imaging assessment.All authors reviewed and edited the manuscript and approved the final version of the manuscript.

  • 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.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

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