Eosinophilic fasciitis following Sars-Cov2 Vaccination
Description
Eosinophilic fasciitis (EF) is a rare scleroderma-like syndrome considered an autoimmune disease (1,2). It was first described by Shulman in 1974 (3) characterized by induration of the skin, peripheral eosinophilia, hypergammaglobulinemia and elevated erythrocyte sedimentation rate (ESR). The disorder occurs equally in males and females and the average age of onset has been reported between 40 and 50 years, although it can appear from childhood to older ages (4). The etiology of EF remains unknown. Multiple triggers have been suggested such as muscle trauma, drugs (statins, phentytoin, ramipril, subcutaneous heparin or trichloroethylene), infections (Borrelia burgdorferi, Mycoplasma arginini), hematologic disorders, solid neoplasms, autoimmune diseases or physical factors such as radiotherapy and burns (1). Clinically, EF is characterized by an abrupt onset of pain and swelling on the affected extremities, mainly with a symmetrical presentation. The edema is followed by the thickening of the skin, showing the two characteristic signs of the disease: Peau d’orange appearance and the “groove sign”, a depression along the course of superficial veins, accentuated with the elevation of the limb. Other symptoms are joint contractures, morphea-like lesions, inflammatory polyarthritis, myalgia, weight loss, asthenia and morning stiffness. Less frequently restrictive lung disease manifestations may be associated and pleural and pericardial effusion as well as renal involvement can also be present (1,5).