An amyotrophic lateral sclerosis mimicker: eosinophilic fasciitis

Eosinophilic fasciitis (EF) is a rare localized scleroderma-like disorder 1 .Until today both the etiology and pathomechanism remain elusive.In general, the skin changes are symmetric and include an initial edema and erythema of the extremities, followed by 'peau d'orange' and woody skin induration in a later phase.The skin induration can lead to joint contractures with limited mobility.Laboratory tests may show hypergammaglobulinemia, peripheral eosinophilia and an elevated erythrocyte sedimentation rate 2 .Clinical pictures of lower motor neuron (LMN) disease associated to EF have already been described 3,4 .The classical features of amyotrophic lateral sclerosis (ALS) are a combination of upper motor neuron (UMN) and LMN signs on examination and/or electromyography (EMG) without sensory, extraocular muscle or sphincter involvement 1 .We present an unusual report of a patient with EF and clinical and EMG characteristics of a lower neuron disease suggestive of motor neuron disease (MND), such as ALS.We also discuss the role of clinical signs in differential diagnosis of MND and some ALS mimickers.