A 30-year-old manual labourer develops painful swelling and induration of both forearms after unaccustomed heavy exercise. Skin thickening stops abruptly at the wrists and ankles, a linear depression runs along the course of the superficial veins, and peripheral smear shows eosinophilia. Raynaud phenomenon is absent. The most likely diagnosis is:

• A Diffuse cutaneous systemic sclerosis
• B Scleromyxoedema
• C Morphea profunda
• D Eosinophilic fasciitis ✓

Explanation

Eosinophilic fasciitis (Shulman disease) follows strenuous exertion, produces woody induration of the limbs with sparing of the hands and face, and shows the groove sign, a depression along superficial veins. Peripheral eosinophilia, hypergammaglobulinaemia and raised ESR support it, and biopsy of full-thickness fascia confirms inflammation. Absence of Raynaud phenomenon and acral involvement excludes systemic sclerosis, and it is linked to aplastic anaemia.

Reference: Fitzpatrick's Dermatology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.