977 RECURRENT PANNICULITIS ASSOCIATED WITH CYTOTOXIC T LYMPHOCYTES

Abstract

There is little understanding of the pathogenesis of recurrent panniculitis. It was therefore of interest to find a patient with widespread panniculitis characterized by a specific pattern of inflammatory lymphocytes in the lesions. The C-reactive protein (5.4 mg/dl) and serum immunoglobulins were elevated. Cultures of the lesions were sterile. Her indium-labelled blood leukocytes were found at the sites of subcutaneous lesions. Biopsies of the lesions revealed a lobular panniculitis characterized by many lymphocytes and macrophages but few other types of leukocytes. In addition, few lymphocytes or macrophages were found in the dermis. The types of lymphocytes in the lesions were examined by immunoperoxidase techniques. No immunoglobulin containing cells were found; virtually all lymphocytes were OKT3 positive. Furthermore, no OKT4 positive cells were found, whereas many OKT8 positive cells were identified. She was treated with oral prednisone because of the sensitivity of cytotoxic/suppressor I cells to corticosteroids. Following that treatment, the lesions desappeared promptly and repeat indium scan showed no leukocyte migration to the skin lesions. Furthermore, when the corticosteroid dose was reduced, the lesions rapidly reappeared and the immunohistopathology of those lesions was indistinguishable from the initial ones. Thus, it appears that the panniculitis in this case may be associated with an influx of cytotoxic T cells.