Published in:
30-07-2022 | Systemic Sclerosis | Clinical Image
The groove sign in eosinophilic fasciitis
Published in: Clinical Rheumatology | Issue 12/2022
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A 56-year-old previously healthy man presented with a 1-month history of swelling of the extremities, with a 7-kg weight gain. Physical examination revealed bilateral pitting edema in the forearms and legs, with erythema and skin induration. On limb elevation, he was noted to have depression along the course of the superficial veins, consistent with the groove sign (Fig. 1A and B). Blood test revealed eosinophilia (6 400 cells per mm3) with normal creatine phosphokinase level. Magnetic resonance imaging showed an edematous infiltrate of subcutaneous tissues and an increased signal in the deep fascia (Fig. 1C). Skin-to-muscle biopsy demonstrated inflammatory infiltrate (mostly constituted of lymphocytes TCD8, plasma cells and eosinophils) along the fascia, with an extension to the adjacent muscle (Fig. 1D).
Fig. 1
A and B: “the groove sign”; it has been hypothesized that the epidermis and superficial dermis around the vessels were less affected by the fibrotic process than the deep tissue. On elevation of the affected limb (which decrease the blood flow), the superficial layers of the veins are pulled inwards, creating the characteristic indentation. C: markedly increased signal intensity within the deep fascia on magnetic resonance imaging (short TI inversion recovery sequence; white arrows). D: Skin infiltrate composed of lymphocytes (black arrow) and few eosinophils (red arrow)
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