Baricitinib for Refractory Eosinophilic Fasciitis: Myth or Reality?

We read the recent article by Sehgal et al with great interest.1 The authors described a 37-year-old patient with eosinophilic fasciitis (EF) who showed no improvement after an initial aggressive treatment strategy (intravenous [IV] methylprednisolone, prednisone, methotrexate, mycophenolate mofetil, and IVIG). Subsequently, the use of the Janus kinase ( JAK) 1/2 inhibitor baricitinib resulted in considerable improvement in the patient's symptoms and skin appearance. However, there are some details that need further clarification.

Eosinophilic fasciitis (Shulman disease) with clinical, imaging and pathological correlation

Eosinophilic fasciitis (EF) is a rare subacute fibrosing disorder of unknown aetiology, characterised by thickening of the muscular fascia and subcutaneous tissue, leading to swelling of limbs and trunk and sparing fingers and toes. Eosinophilic infiltration and degranulation may prompt tissue damage and consequent fibrosis due to the accumulation of collagen and extracellular matrix proteins. MRI is the best imaging modality for diagnosis, depicting fascial thickening and enhancement. MRI may also have a significant role in excluding alternative diagnosis and guiding the skin–muscle biopsy.We report a case of EF with clinical and pathological correlation, highlighting the diagnostic value of MRI for early diagnosis and further treatment.