Dermatologic Manifestations of Eosinophilia-Myalgia Syndrome Differential Diagnoses

Updated: Apr 16, 2021
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: William D James, MD  more...
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Diagnostic Considerations

Also consider toxic oil syndrome, [33, 34, 35]  polymyositis, and polyarteritis nodosa.

Eosinophilic fasciitis should be differentiated from eosinophilia-myalgia syndrome (EMS). [36, 37, 38, 39] Eosinophilic fasciitis is typically evident as painful swelling with progressive cutaneous and subcutaneous induration of the limbs. [40] The criterion standard for diagnosis of eosinophilic fasciitis is a deep skin-to-muscle biopsy. Some believe eosinophilic fasciitis to be linked to L-tryptophan ingestion, statins, and, possibly, iron infusions. [41]

Probiotics, live microorganisms that when administered confer a health benefit, are often used for rheumatic diseases to enhance the immune system despite adverse events including bacteremia and fungemia in immunocompromised patients. Two patients developed a severe eosinophilic syndrome with vasculitis and mononeuritis multiplex, temporally associated with use of a new brand of probiotics. [42] However, neither had the eosinophilia myalgia syndrome since there was no cutaneous edema, no fibrosis, and no history of L-tryptophan ingestion.

Other hypereosinophilic syndromes should be considered, especially immunoglobulin G4–related disease, but also including eosinophilic fasciitis, drug-induced vasculitis, and toxic oil syndrome. [43]

Differential Diagnoses