Bilateral Eosinophilic Fasciitis in a 34-Year-Old Woman: A Case Report

Background: Eosinophilic fasciitis (EF), also known as Shulman syndrome, is a rare inflammatory connective tissue disorder characterized by fascial inflammation, peripheral eosinophilia, and progressive limb induration. Owing to clinical overlap with systemic sclerosis and inflammatory myopathies, diagnosis may be delayed. Case Presentation: We describe a 34-year-old Caucasian woman presenting with progressive skin tightening of the upper and lower extremities, burning forearm sensations, limited elbow extension, and spontaneous thigh bruising. Laboratory evaluation revealed marked eosinophilia (absolute eosinophil count 3703/μL) and elevated inflammatory markers. Autoimmune serologies were negative. Magnetic resonance imaging (MRI) of the right humerus demonstrated diffuse fascial edema and inflammation. Full-thickness biopsy of the left upper inner arm confirmed fascial thickening with lymphocytic infiltrates, consistent with eosinophilic fasciitis. Management and Outcome: Treatment with oral prednisone and methotrexate as a steroid-sparing agent resulted in progressive clinical improvement, normalization of inflammatory markers, restoration of skin flexibility, and recovery of joint mobility. Prednisone was successfully tapered and discontinued. The patient remains stable on a tapering methotrexate regimen. Conclusion: Early recognition of eosinophilic fasciitis and prompt initiation of immunosuppressive therapy are essential to prevent long-term fibrosis and functional impairment.