PMC5635288_01
PMC5635288_02
Coronal STIR and axial T1-weighted postcontrast SPIR magnetic resonance images of the upper (a), middle (b), and lower (c) right thigh. The images show considerable and diffuse inflammatory changes along the fasciae of all muscles of the right lower thigh (arrows) and surrounding the cortical bone of the distal femur (dotted arrow), and severe inflammatory changes surrounding the vessels of the popliteal fossa and subcutaneously at the knee level extending cranially along the lateral side of the thigh (circle).
CRIRH2017-4029271.001.jpg
PMC5635288_02_CRIRH2017-4029271.001.jpg
fig1
At age 43 years, MRI (Figure 1()) showed considerable inflammatory changes along the fasciae of all muscles of the distal right thigh and severe subcutaneous contrast enhancement.
Photography of the patient with bluish red indurated patches of the right lower leg extending up through the lateral part of the thigh, with swelling of the entire right leg. The patient had covered an ulcerating element with band aid.
CRIRH2017-4029271.002.jpg
PMC5635288_02_CRIRH2017-4029271.002.jpg
fig2
At this stage, over a year after the first hard skin elements of the right lower leg had emerged, the skin changes had progressed from the lower leg up through the thigh, and the clinical presentation of the patient was suggestive of an infectious etiology (Figure 2()).
PET-CT showed pronounced inflammatory cutaneous changes of the entire circumference of the right leg and of fasciae surrounding several muscles. Minor inflammatory changes of the subcutis and muscle fasciae of the left leg are also present. (a) Upper part of thigh. (b) Lower thigh. (c) Upper part of lower leg.
CRIRH2017-4029271.003.jpg
PMC5635288_02_CRIRH2017-4029271.003.jpg
fig3
A PET-CT scan (Figure 3()) showed pronounced inflammatory cutaneous changes of almost the whole right leg with possible muscular involvement, patchy inflammatory changes of the muscles and skin of the left leg, lymphadenitis of the inguinal and iliac lymph nodes, and minor skin changes of the right upper arm similar to those of the right leg.