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Requests for reprints should be addressed to Ami Schattner, MD, Professor of Medicine, Faculty of Medicine, Hebrew University and Hadassah Medical School, Jerusalem, Israel.
A 66-year-old woman complained of gradual swelling and hardening of the skin of all
limbs over 2 months, which started distally in the legs and progressed upward, symmetrically,
and was associated with difficulties in function and a weight gain of 10%. Examination
was notable for diffuse marked limb edema (mostly nonpitting) and hardening of the
skin with prominent peau d'orange appearance of the cubital fossa (Figures 1A and 1B). The examination was otherwise normal. Her past history included obesity,
diabetes and dyslipidemia treated with empagliflozin and atorvastatin. When blood
count revealed eosinophilia (absolute count 3270, normal hemoglobin and platelets)
she was admitted to a teaching hospital.
Figure 1(A) “Peau d'orange” appearance of the patient's cubital fossa. Note proximal and distal
swelling (and hardening) of the upper limb. (B) Swelling and hardening of the skin of the lower legs, with both pitting and nonpitting
edema.
