Eosinophilic fasciitis (Shulman syndrome), a rare entity and diagnostic challenge, as a manifestation of severe chronic graft-versus-host disease: a case report
Abstract Background Shulman’s disease, or eosinophilic fasciitis (EF), is a rare autoimmune disease, characterized by sclerodermic skin lesions with progressive induration and thickening of the soft tissues. Chronic graft-versus-host-disease (GVHD) presenting as EF is a very rare manifestation of cu...
Main Authors: | , , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
BMC
2021-03-01
|
Series: | Journal of Medical Case Reports |
Subjects: | |
Online Access: | https://doi.org/10.1186/s13256-021-02735-3 |
id |
doaj-13e750549c8f4743b96eb9b69bd12d34 |
---|---|
record_format |
Article |
spelling |
doaj-13e750549c8f4743b96eb9b69bd12d342021-03-21T12:17:58ZengBMCJournal of Medical Case Reports1752-19472021-03-011511510.1186/s13256-021-02735-3Eosinophilic fasciitis (Shulman syndrome), a rare entity and diagnostic challenge, as a manifestation of severe chronic graft-versus-host disease: a case reportThomas Chalopin0Nicolas Vallet1Marion Morel2Raphael Maguet3Louis d’Alteroche4Gonzague de Pinieux5Olivier Hérault6Emmanuel Gyan7Laurent Sutton8Alban Villate9Department of Hematology and Cell Therapy, University Hospital of ToursDepartment of Hematology and Cell Therapy, University Hospital of ToursDepartment of Medical Imaging, University Hospital of ToursDepartment of Hematology and Cell Therapy, University Hospital of ToursDepartment of Hepatology, University Hospital of ToursDepartment of Pathology, University Hospital of ToursDepartment of Biological Hematology, University Hospital of ToursDepartment of Hematology and Cell Therapy, University Hospital of ToursDepartment of Hematology and Cell Therapy, University Hospital of ToursDepartment of Hematology and Cell Therapy, University Hospital of ToursAbstract Background Shulman’s disease, or eosinophilic fasciitis (EF), is a rare autoimmune disease, characterized by sclerodermic skin lesions with progressive induration and thickening of the soft tissues. Chronic graft-versus-host-disease (GVHD) presenting as EF is a very rare manifestation of cutaneous GVHD. Case presentation We report an unusual case of EF in a 46-year-old Caucasian male patient who had received an allogenic hematopoietic stem cell transplantation in the context of relapsed/refractory multiple myeloma. The diagnosis was challenging, with the patient presenting hepatic dysfunction, normal eosinophils count, and incomplete clinical signs. Magnetic resonance imaging (MRI) and skin biopsy confirmed the diagnosis of EF. Early initiation of specific treatment with corticosteroids and prednisolone achieved complete response. Conclusion In practice, incomplete signs in this rare complication should lead to MRI as it is a major tool to guide decision-making based on the skin biopsy, allowing a rapid diagnosis and the initiation of treatment without delay.https://doi.org/10.1186/s13256-021-02735-3Multiple myelomaAllogenic hematopoietic stem cell transplantationEosinophilic fasciitisChronic graft-versus-host-disease |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Thomas Chalopin Nicolas Vallet Marion Morel Raphael Maguet Louis d’Alteroche Gonzague de Pinieux Olivier Hérault Emmanuel Gyan Laurent Sutton Alban Villate |
spellingShingle |
Thomas Chalopin Nicolas Vallet Marion Morel Raphael Maguet Louis d’Alteroche Gonzague de Pinieux Olivier Hérault Emmanuel Gyan Laurent Sutton Alban Villate Eosinophilic fasciitis (Shulman syndrome), a rare entity and diagnostic challenge, as a manifestation of severe chronic graft-versus-host disease: a case report Journal of Medical Case Reports Multiple myeloma Allogenic hematopoietic stem cell transplantation Eosinophilic fasciitis Chronic graft-versus-host-disease |
author_facet |
Thomas Chalopin Nicolas Vallet Marion Morel Raphael Maguet Louis d’Alteroche Gonzague de Pinieux Olivier Hérault Emmanuel Gyan Laurent Sutton Alban Villate |
author_sort |
Thomas Chalopin |
title |
Eosinophilic fasciitis (Shulman syndrome), a rare entity and diagnostic challenge, as a manifestation of severe chronic graft-versus-host disease: a case report |
title_short |
Eosinophilic fasciitis (Shulman syndrome), a rare entity and diagnostic challenge, as a manifestation of severe chronic graft-versus-host disease: a case report |
title_full |
Eosinophilic fasciitis (Shulman syndrome), a rare entity and diagnostic challenge, as a manifestation of severe chronic graft-versus-host disease: a case report |
title_fullStr |
Eosinophilic fasciitis (Shulman syndrome), a rare entity and diagnostic challenge, as a manifestation of severe chronic graft-versus-host disease: a case report |
title_full_unstemmed |
Eosinophilic fasciitis (Shulman syndrome), a rare entity and diagnostic challenge, as a manifestation of severe chronic graft-versus-host disease: a case report |
title_sort |
eosinophilic fasciitis (shulman syndrome), a rare entity and diagnostic challenge, as a manifestation of severe chronic graft-versus-host disease: a case report |
publisher |
BMC |
series |
Journal of Medical Case Reports |
issn |
1752-1947 |
publishDate |
2021-03-01 |
description |
Abstract Background Shulman’s disease, or eosinophilic fasciitis (EF), is a rare autoimmune disease, characterized by sclerodermic skin lesions with progressive induration and thickening of the soft tissues. Chronic graft-versus-host-disease (GVHD) presenting as EF is a very rare manifestation of cutaneous GVHD. Case presentation We report an unusual case of EF in a 46-year-old Caucasian male patient who had received an allogenic hematopoietic stem cell transplantation in the context of relapsed/refractory multiple myeloma. The diagnosis was challenging, with the patient presenting hepatic dysfunction, normal eosinophils count, and incomplete clinical signs. Magnetic resonance imaging (MRI) and skin biopsy confirmed the diagnosis of EF. Early initiation of specific treatment with corticosteroids and prednisolone achieved complete response. Conclusion In practice, incomplete signs in this rare complication should lead to MRI as it is a major tool to guide decision-making based on the skin biopsy, allowing a rapid diagnosis and the initiation of treatment without delay. |
topic |
Multiple myeloma Allogenic hematopoietic stem cell transplantation Eosinophilic fasciitis Chronic graft-versus-host-disease |
url |
https://doi.org/10.1186/s13256-021-02735-3 |
work_keys_str_mv |
AT thomaschalopin eosinophilicfasciitisshulmansyndromearareentityanddiagnosticchallengeasamanifestationofseverechronicgraftversushostdiseaseacasereport AT nicolasvallet eosinophilicfasciitisshulmansyndromearareentityanddiagnosticchallengeasamanifestationofseverechronicgraftversushostdiseaseacasereport AT marionmorel eosinophilicfasciitisshulmansyndromearareentityanddiagnosticchallengeasamanifestationofseverechronicgraftversushostdiseaseacasereport AT raphaelmaguet eosinophilicfasciitisshulmansyndromearareentityanddiagnosticchallengeasamanifestationofseverechronicgraftversushostdiseaseacasereport AT louisdalteroche eosinophilicfasciitisshulmansyndromearareentityanddiagnosticchallengeasamanifestationofseverechronicgraftversushostdiseaseacasereport AT gonzaguedepinieux eosinophilicfasciitisshulmansyndromearareentityanddiagnosticchallengeasamanifestationofseverechronicgraftversushostdiseaseacasereport AT olivierherault eosinophilicfasciitisshulmansyndromearareentityanddiagnosticchallengeasamanifestationofseverechronicgraftversushostdiseaseacasereport AT emmanuelgyan eosinophilicfasciitisshulmansyndromearareentityanddiagnosticchallengeasamanifestationofseverechronicgraftversushostdiseaseacasereport AT laurentsutton eosinophilicfasciitisshulmansyndromearareentityanddiagnosticchallengeasamanifestationofseverechronicgraftversushostdiseaseacasereport AT albanvillate eosinophilicfasciitisshulmansyndromearareentityanddiagnosticchallengeasamanifestationofseverechronicgraftversushostdiseaseacasereport |
_version_ |
1724210715596685312 |