In 1975 Shulman described eosinophilia fasciitis as a symmetrical and painful swelling and a progressive hardening of the skin and soft tissues with abnormally thick fascia.  Typically oral steroids, immunosuppressive drugs and immunomodulatory drugs are the standard treatment.  (Picture in link) The etiology of EF is unclear at this time. It has been associated with trauma, physical exertion, Lyme disease, arthropod bites, ingestion of L-tryptophan, and statins. EF or EF-like conditions have also been reported in association with treatments for multiple sclerosis, such as dimethyl fumarate.

The following abstracts; however, reveal a possible connection to borrelia infection.  If infection is the culprit, the standard treatment will make the infection worse.

[Eosinophilic fasciitis associated with Borrelia burgdorferi infection].

Belot V, et al. Ann Dermatol Venereol. 2007 Aug-Sep.

BACKGROUND: Eosinophilic fasciitis (Shulman syndrome) is defined by the association of sclerodermatous skin changes involving underlying fascia and hypereosinophilia. While the aetiology is unknown, some observations suggest an infectious origin. We report the association of eosinophilic fasciitis with an infection involving Borrelia burgdorferi.

PATIENTS AND METHODS: A 54 year-old man consulted for a hardened oedema and stiffness of the calves associated with an oedema of the left hand evolving for 4 months. Routine blood tests showed hypereosinophilia at 1.01 G/l and moderate inflammatory syndrome. Diagnosis of eosinophilic fasciitis was confirmed by MRI and muscle biopsy. Since the patient had reported previous tick bites some months before onset, he was tested for Lyme disease. An ELISA test revealed IgG directed against Borrelia burgdorferi and this was confirmed by Western blot analysis.

DISCUSSION: The association of eosinophilic fasciitis with Lyme disease raises the question of a real link or a fortuitous association between the two conditions. Similar cases have been described in the literature with or without isolation of the spirochete from skin or fascia lesions. The incidence of eosinophilic fasciitis remains low compared to the prevalence of the infection in endemic areas. We suggest that in some patients, perhaps genetically predisposed, infection with B. burgdorferi may be at the origin of fasciitis.

Eosinophilic fasciitis (Shulman syndrome).

Mosconi S, et al. Dermatology. 2002.


We report a case of a 30-year-old Caucasian patient with progressive sclerosis of the skin mainly on the upper limbs which was diagnosed as eosinophilic fasciitis (Shulman syndrome). Circulating antibodies against Borrelia burgdorferi were detected. The association of B. burgdorferi infection with eosinophilic fasciitis is discussed.