Lymph-node-based malignant lymphoma and reactive lymphadenopathy in eosinophilic fasciitis

Background: Lymph node enlargement in patients with eosinophilic fasciitis is a rare occurrence and its clinical significance is unknown. Methods: The literature and authors' registries were searched for eosinophilic fasciiti s associated with lymphadenopathy. Clinical data, time sequence of appearan ce of either disorder, and pathological diagnoses were analyzed. Results: S ix patients presenting with eosinophilic fasciitis had a lymph-node-based l ymphoma and 4 patients had a reactive lymphadenopathy. The patients with ly mphoma were elderly and the subcutaneous induration preceded the lymphadeno pathy by 2 to 36 months. The patients with eosinophilic fasciitis and react ive lymphadenopathy were young and the onset of subcutaneous induration and lymph node enlargement coincided with one another. Favorable response of t he eosinophilic fasciitis to prednisone therapy was attained in 3 of 3 pati ents with reactive lymphadenopathy and in 4 of the 6 cases with lymphoma. C onclusions: Eosinophilic fasciitis is rarefy associated with clinically sig nificant lymph node enlargement. Subcutaneous induration preceding the lymp hadenopathy by 6 months or more, especially in elderly patients, suggests a n underlying lymphoma. A favorable response of the subcutaneous induration to prednisone treatment does not exclude the diagnosis of lymphoma; therefo re, it does not supersede the need of a pathological evaluation. A lymph no de biopsy is mandatory in all cases.