Lancet Case Report: Grooves Around the Veins

July 22, 2014

A 71-year-old woman with one month of joint pain showed a classic sign of eosinophilic fasciitis.

Pinal-Fernandez IP, Moraga ELC, Tato MLR, Simeon-Aznar CP. Groove sign in eosinophilic fasciitis. The Lancet (2014) Online July 18, 2014 doi:10.1016/S0140-6736(14)60526-2

A 71-year-old woman with no prior history presented with one month of joint pain.

She also had cutaneous edema, with subcutaneous hardening that started in her legs, then spread to the trunk and arms. Blood tests showed eosinophilia. Skin and muscle biopsy showed macrophage infiltration of the fascia, and eosinophilic infiltrate of the vessels, suggestive of eosinophilic fasciitis.

After prednisone and methotrexate, the eosinophilia and cutaneous edema resolved, but the subcutaneous hardening recovered slowly and incompletely over 10 months.

Both forearms showed the “groove sign” – a linear depression in the skin parallel to the course of the superficial veins, which is prominent on raising the arms, and characteristic of eosinophilic fasciitis. Because the fibrotic process spares the upper dermis and epidermis, and the connective tissue around the veins is relatively immobile, the superficial layers of skin can bow inward as the peripheral venous pressure falls.