Age / Sex : 37 / M

Age/Sex : 37/M

Chief complaint : Both calf pain
Onset - 5~6 MA

Ass sx : Rt forearm pain and swelling, both thigh pain

What is your diagnosis?

Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer)

Courtesy : 김민지 (Min Jee Kim), 전북대학교병원 (Jeonbuk National University Hospital)

Bilateral eosinophilic fasciitis (=Shulman’s syndrome)

Discussion

Rare disease of unknown etiology and pathogenesis manifesting in a scleroderma-like clinical presentation
(cutaneous manifestations, which include edema, skin induration or so-called orange peel or cobblestone skin with hyperpigmentation)
The average age of onset is approximately 40–50 years
Lab findings : peripheral eosinophilia, hyper gamma-globulinemia and an elevated erythrocyte sedimentation rate
Diagnosis : A full-thickness wedge biopsy of the clinically affected skin
Treatment : Good responsiveness to corticosteroid therapy

Findings
T2WI : diffuse deep fascia thickening with edema and hyper intensity
Marked enhancement
T1WI : prominent fascial thickening with slightly increased signal intensity relative to that of muscle 

References
1. Eosinophilic Fasciitis: Spectrum of MRI Findings; AJR 2005;184:975–978
2. Eosinophilic fasciitis: Typical abnormalities, variants and differential diagnosis of fasciae abnormalities using MR imaging, Diagnostic and Interventional Imaging (96-4); 2015; 341-348,