Eozinofilni fasciitis udružen s Parkinsonovim sindromom – prikaz bolesnika

Vesna Budišin, Dragica Vrabec-Matković, Višnja Milavac-Puretić

We present a 67 year old patient with erythema and swelling of the right arm. Suspected erysipelas and lymphedema are diagnosed at infectious department in the second month of the disease. He was treated with parenteral antibiotics (clindamycin + quinolon). Aft er that, he was hospitalized at rheumatology department as right hand lymphedema, condition aft er erysipelas, cervicobrachial syndrome and ulnar epicondylitis of right elbow. Lymphatic drainage of right hand was performed, but with no effect. In the seventh month of the disease, the diagnosis of eosinophilic faciitis was established and started treatment with corticosteroids. Besides mentioned, dizziness, tremor, balance disorders, impaired hearing and pain in the cervical and lumbar spine were apeared. The therapy was introduced with levodopa and ropanirol and there is a slight improvement of neurological manifestations of extrapyramidal syndrome. Aft er 18 months of disease the patient has a contracture of his right shoulder, induration and painful movements right forearm, pronounced tremor of the head and hands, balance disorders, neck pain and back pain, difficulty in walking.

Prikazujemo 67 godišnjeg bolesnika u kojeg se pojavio eritem i oticanje desne ruke. Dijagnosticiran je suspektni erizipel i limfedem na zaraznom odjelu u drugom mjesecu bolesti. Liječen je parenteralno antibioticima (klindamicin+kinolon). Nakon toga je hospitaliziran na reumatološkom pod dijagnozom limphedema desne ruke, stanja nakon erizipela, cervikobrahijalnog sindroma i ulnarnog epikondilitisa desnog lakta. Provedena je limfna drenaža desne ruke i lokalni nalaz ostao je nepromjenjen. U sedmom mjesecu bolesti postavljena je dijagnoza eozinofilnog fasciitisa i započeto je liječenje kortikosteroidima. Usporedno se javlja vrtoglavica, tremor, smetnje ravnoteže, oslabljen sluh te bolovi u vratnoj i slabinskoj kralježnici. U terapiju je uvedena levodopa i ropanirol te dolazi do laganog poboljšanja neuroloških manifestacija ekstrapiramidnog sindroma. Nakon 18 mjeseci bolesti bolesnik ima kontrakturu desnog ramena, induracije i bolne kretnje desne podlaktice, izražen tremor glave i ruku, smetnje ravnoteže, bolove u vratu i križima, otežan hod.