嗜酸性筋膜炎1例

A case of eosinophilic fasciitis

报告1例嗜酸性筋膜炎。患者男,58岁,四肢肌肉僵硬无力伴关节疼痛11个月。皮肤科检查:双前臂皮肤沿静脉走向呈沟槽状表现,手臂抬高时沟槽征明显,双前臂及双小腿皮肤僵硬难以提起或移动,双小腿皮肤紧绷,表面蜡样光泽,伴肌肉无力及疼痛,右前臂肌无力症状较重。外院实验室检查:2020年12月嗜酸性粒细胞绝对值1.51×10^(9)/L;2021年6月嗜酸性粒细胞绝对值0.45×10^(9)/L,血沉104 mm/h,免疫球蛋白IgG 32.7 g/L,C30.881 g/L,γ球蛋白36.5%,抗Scl-70抗体阴性。右前臂筋膜组织病理示:表皮萎缩,筋膜区胶原增粗,透明变性,血管周围较多浆细胞、淋巴细胞、嗜酸性粒细胞,筋膜区弹力纤维几乎消失,阿辛蓝染色(+)。诊断:嗜酸性筋膜炎。予口服巴瑞替尼4 mg每日1次,患者因担心药物副作用未服用该药物,目前已失访。

We report a case of eosinophilic fasciitis.A 58-year-old man complained of muscle weakness and stiffness,and joint pain of the limbs for 11 months.Dermatological examination revealed groove sign,which became more prominent when raising the arm.The skin of the forearms and calves was waxy appearance and tight.Muscle weakness and pain were apparent.The laboratory examination showed the absolute eosinophil count was 1.51×10^(9)/L in December,2020,and 0.45×10^(9)/L in June,2021.The erythrocyte sedimentation rate was 104 mm/h.Other test results were immunoglobulin G(IgG)32.7 g/L,C30.881 g/L,gamma globulin 36.5%,and the anti-Scl-70 antibody(negative).The histopathology of the lesion on the right forearm was manifested by epidermal atrophy,collagen thickening in the fascia,hyaline degeneration,perivascular infiltration of plasma cells,lymphocytes,and eosinophils,remarkable reduction in elastic fibers in the fascia,and alcian blue stain(+).Patient was diagnosed with eosinophilic fasciitis.The patient refused the treatment with baricitinib and was without follow up.