Atypical course of an (eosinophilic) fasciitis

A 22-year old male patient developed - following a short phase of monarthritis - the symptoms of a symmetric, polysynoviatic, discrete erosive rheumatoid arthritis, thus fulfilling five of seven ACR criteria. Initially as well as persisting during the course of the disease the palpable swelling of synovitis showed a coarse character. The radiological progression at the hands during an interval of eight years being only minimal the loss of functions, up to contraction of joints (left hip) augmented considerably during that time. Neither rheumatoid factor or antinuclear antibodies nor evident eosinophilia or hypergammaglobulinaemia could be proved or verified. In 1994 muscle biopsy led to the diagnosis ''fasciitis with low-graded eosinophilia''. Anamnestic, clinical and radiological signs and data as well as the course of the disease and assessing of differential diagnoses are presented and discussed.