The groove sign
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Samuel G. Cook
and
Alan J. Bartholomew
A 26-year-old man presented to a rheumatology clinic in October 2021 with complaints of recurrent polyarticular joint pain and decreased flexibility. Three years prior he was diagnosed with eosinophilic fasciitis and had minimal symptoms after treatment with methotrexate, prompting discontinuation of his medications. One year later he had recurrence of joint pain and skin tightness. He was prescribed prednisone 40 mg daily and upon presentation to the rheumatology clinic his joint pain had resolved but skin symptoms persisted. A physical examination was notable for the “groove sign” (Figure 1) characteristic of eosinophilic fasciitis. Laboratory studies revealed mildly elevated erythrocyte sedimentation rate (ESR, 17 mm/h), normal C-reactive protein (CRP, <0.5 mg/dL), and white blood cell count (WBC, 6,700 cells/mcL, 0.7% eosinophils). MRI of the right upper extremity showed minimal fascial edema and enhancement between flexor muscles of the forearm. His symptoms resolved within 2 months with prednisone and resuming methotrexate.
Photograph of the groove sign on the right forearm, characterized by skin indentation along superficial veins.
Eosinophilic fasciitis is a rare disease with an unknown incidence and unclear etiology [1]. It is characterized by acute onset swelling and skin induration of the extremities, often with arthritis, myalgias, and initially peripheral blood eosinophilia [2]. The gold standard for diagnosis is full thickness skin-to-muscle biopsy, although MRI is commonly used [2]. The groove sign occurs because fascial fibrosis creates immobile connective tissue around the veins while the epidermal and dermal layers remain unaffected. When the limb is elevated, venous pressure falls and the overlying skin indents along the course of superficial veins [3]. Treatment involves several weeks of high-dose glucocorticoids, often followed by methotrexate as a steroid-sparing agent [2]. Some patients achieve clinical remission allowing for discontinuation of immunosuppressants, but relapses are common [2].
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Research funding: None reported.
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Author contributions: S.G.C. provided substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; S.G.C. drafted the article or revised it critically for important intellectual content; S.G.C. gave final approval of the version of the article to be published; and both authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
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Competing interests: None reported.
References
1. Shulman, LE. Diffuse fasciitis with eosinophilia: a new syndrome? Trans Assoc Am Phys 1975;88:70–86.Search in Google Scholar
2. Mazori, DR, Femia, AN, Vleugels, RA. Eosinophilic fasciitis: an updated review on diagnosis and treatment. Curr Rheumatol Rep 2017;19:74. https://doi.org/10.1007/s11926-017-0700-6.Search in Google Scholar PubMed
3. Fruchter, R, Mazori, DR, Femia, AN. Groove sign of eosinophilic fasciitis. J Clin Rheumatol 2017;23:169. https://doi.org/10.1097/RHU.0000000000000524.Search in Google Scholar PubMed
© 2022 the author(s), published by De Gruyter, Berlin/Boston
This work is licensed under the Creative Commons Attribution 4.0 International License.
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- Frontmatter
- Cardiopulmonary Medicine
- Case Report
- Safe endovascular retrieval of a vena cava filter after duodenal perforation
- General
- Original Article
- Mask-related skin changes among healthcare workers in a community-based hospital
- Medical Education
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