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The groove sign

By JOM Staff

12.19.22

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.