Successful treatment with methotrexate for eosinophilic fasciitis

Abstract

A man in his 80s had an edematous erythema and induration of the upper and lower extremities 4 months before his visit to our hospital. His medical history included an enlarged prostate, but he was otherwise healthy. His arms, upper back, and legs were symmetrically indurated, and his legs had a peculiar cobblestone appearance. These joints showed normal range of motion. He did not have Raynaud phenomenon or nail-fold capillary abnormalities. Axial T2-weighted post-contrast magnetic resonance imaging revealed abnormal diffuse thickening and enhancement of the fascial planes of the bilateral femoral biceps. Fascial biopsy showed fascial thickening with lymphocyte accumulation. Therefore, he was diagnosed with eosinophilic fasciitis (EF). Prednisolone 40 mg daily was started, but gradually reduced; the serum aldolase level was elevated. We added methotrexate (MTX) 3 months after the start of prednisolone treatment. Subsequently, the skin induration was improved, and the serum aldolase level was reduced; we were able to gradually reduce prednisolone. Currently, the toxicities of MTX are not found. MTX seems to be an effective treatment option for steroid-dependent or steroid-resistant EF.