A 43-year-old African-American female with
anemia secondary to uterine
leiomyomas and
menorrhagia presented with induration and stiffness of the right arm and hand four weeks after receiving intravenous
iron infusions at multiple infusion sites along the right proximal forearm. Multiple intravenous sites between her right antecubital fossa and wrist had to be used because developing
pain necessitated the site changes. The
iron infusions were performed because the patient had refused
blood transfusions and her symptoms failed to resolve on oral
iron supplementation. The skin induration persisted and progressed for several months at which time a skin biopsy was performed. The skin histology was consistent with
eosinophilic fasciitis and her complete blood count was notable for a peripheral
eosinophilia. Because of the location of the
fibrosis and the time proximity in relation to her infusions, a relationship between the
iron infusions and
eosinophilic fasciitis was made. Cutaneous
fibrosis has been linked to immunologic dysfunction,
autoantibody production, tissue
hypoxia, and vascular damage, which may have been contributing factors in this patient.
Eosinophilic fasciitis has been linked to certain drugs and chemicals, notably
L-tryptophan ingestion and the
statin family of drugs.