Nodular Panniculitis Research Articles

Panniculite nodulaire et tumeur carcinoïde intracanalaire d’un pancréas divisum

The association of pancreatic diseases with panniculitis are rare. Various pancreatic diseases are described with panniculitis of which most frequent are pancreatitis and acinar cell carcinoma. We report a case of an acute nodular panniculitis whose etiologic assessment allow of discover an intraductal carcinoid tumour on a pancreas divisum. A 45 year-old woman without notable medico-surgical history had suddenly presented with multiple cutaneous erythematous nodules on the legs associated with moderates arthralgia in the wrists and the ankles. There were no other clinical manifestations. Results of laboratory tests and chest X-ray were normal. Histologic exploration showed a centrolobular fat necrosis and suggestive pancreatic disease was confirmed by an increase in serum pancreatic enzymes. Ultrasound study and computerized tomography of the abdomen was without notable anomaly. Endoscopic ultrasound study of the pancreas and magnetic resonance imaging showed moderate distention of the pancreatic duct. Endoscopic retrograde cholangiopancreatography highlighted a small tumor in the accessory duct orifice of the pancreas divisum. Immunohistological study of tumor's biopsy showed a carcinoid tumor. To our knowledge, this observation describes the first case of nodular panniculitis associated with carcinoid tumor of the pancreas. The detection of this tumor at an early stage, revealed by cutaneous fat necrosis, is probably due to the unusual anatomic site, on the accessory papilla of the pancreas divisum.

Gnathostomiasis: clinicopathologic study.

Gnathostomiasis is a systemic parasitic disease that is caused by the ingestion of contaminated raw fish, the intermediate host. Involvement of the skin is a common event, and when it does happen, it can produce a superficial or creeping eruption, pseudofurunculosis, and nodular migratory panniculitis. We carried out a retrospective study of 946 cases of gnathostomiasis; 66 of them had skin biopsies. The diagnosis was made based on clinical and epidemio-logic findings as well as the therapeutic response. The most common skin finding was nodular migratory panniculitis affecting the trunk. Most of the patients were males between 20 and 40 years of age. Histopathologically, we were able to see the larva and make a definitive diagnosis in 15 cases, and in 12 cases, the worm was retrieved during the surgical procedure. In remaining cases, despite of our inability to identify the larva, the histopathologic changes were quite characteristic and included: dermal and hypodermal edema with dense mixed infiltrates composed of eosinophils admixed with lymphocytes and neutrophils, eosinophilic vasculitis, flame figures, areas of necrosis, and hemorrhage. Thus, the presence of these histopathologic features in the context of a clinical picture suggestive of gnathostomiasis allows the pathologist to make the correct diagnosis.

Effective treatment of relapsing idiopathic nodular panniculitis (Pfeifer-Weber-Christian disease) with mycophenolate mofetil

Relapsing idiopathic nodular panniculitis is the term used to describe a group of diseases that presents as subcutaneous inflammatory nodules, fever and systemic symptoms and histopathologically displays inflammation within the fat lobules. There is no specific test for diagnosis and extensive investigations are required to exclude systemic causes of panniculitis. No uniform effective therapy is available and various drugs used include mainly corticosteroids alone or in combination with other immunosuppressive agents. Presented in this paper is an intractable case of idiopathic nodular panniculitis whose corticotherapy failed and could not be continued because of serious adverse effects. The rapid and good therapeutic response of the patient to mycophenolate mofetil monotherapy is discussed.

The men behind the eponym: Frederick Parkes Weber and Henry a. Christian: Weber-Christian disease.

Frederick Parkes Weber described relapsing nonsuppurative panniculitis in 1925. In 1928, Henry Asbury Christian added the word "febrile" (relapsing febrile nodular nonsuppurative panniculitis), whereas Brill first coined the eponym "Weber-Christian disease" in 1936. This article traces the lives of Parkes Weber and Henry Christian and summarizes their original publications. It addresses only briefly the controversy as to whether Weber-Christian disease does or does not exist.

Chronic nodular panniculitis in a three-year-old mare

The clinical signs of chronic nodular panniculitis in a three-year-old mare were consistent with a diagnosis of sterile nodular panniculitis, but the mare had histopathological signs of both generalised steatitis...

Successful Treatment of Idiopathic Febrile Panniculitis (Weber-Christian Disease) with Thalidomide in a Patient Having Failed Multiple Other Medical Therapies

The authors describe a case of idiopathic nodular panniculitis (Weber-Christian disease) with recurrent febrile episodes resistant to glucocorticosteroids and methotrexate (MTX) in various combinations with hydroxychloroquine, azathioprine, cyclosporine, colchicine, and doxycycline. Thalidomide at 100 mg/day has induced a remission for 3 years.

Potassium iodide in dermatology: A 19th century drug for the 21st century—uses, pharmacology, adverse effects, and contraindications

Potassium iodide (KI) is a useful drug in the dermatologic armamentarium. It is successfully used for inflammatory dermatoses, most notably erythema nodosum, subacute nodular migratory panniculitis, nodular vasculitis, erythema multiforme, and Sweet's syndrome. KI is also successfully used for cutaneous and lymphocutaneous sporotrichosis. The precise mechanism by which KI acts is unknown. Although many minor side effects are common with this drug, major side effects can occur in pregnant patients and those with a history of kidney or thyroid disease. This article reviews the pharmacology, mechanism of action, indications, contraindications, and adverse effects of KI as a therapeutic agent. (J Am Acad Dermatol 2000;43:691-7.)

Treatment of 39 nodular panniculitis patients with clearing away heat to remove dampness and promoting blood circulation

Treatment of 39 nodular panniculitis patients with clearing away heat to remove dampness and promoting blood circulation

診断に難渋したＷｅｂｅｒ‐Ｃｈｒｉｓｔｉａｎ病例

Weber-Christian disease (relapsing febrile nonsuppurative nodular panniculitis) is an idiopathic systemic recurrent panniculitis. It usually presents with relapsing fever and subcutaneous nodules that sometimes leave depressions of the skin. The nodules often occur in the head and neck regions, especially the cheeks. Reports of this disease from otorhinolaryngologists are quite rare. We report a case of Weber-Christian disease in the head and neck region.A 57-year-old woman presented with a low grade fever and relapsing nodules in the bilateral cheeks and neck. She had a past history of non-Hodgkin's lymphoma, rheumatoid arthritis, and diabetes mellitus. An exploratory biopsy was performed, and the histology showed granuloma and panniculitis, which indicated Weber-Christian disease. Because we were unfamiliar with this disease, we were unable to make a diagnosis. Afterwards, pleural effusion and nodules in the bilateral forearms occurred, and then the diagnosis of Weber-Christian disease was made.She was successfully treated with prednisolone.

Sterile Nodular Dermatitis in Dogs

The types of canine sterile nodular dermatitis discussed in this article have in common the clinical presentation of nodules or plaques; however, they differ in many aspects such as breed predilection, distribution and evolution of cutaneous lesions, systemic involvement, response to therapy, and prognosis. The definitive diagnosis should be based on multiple skin biopsy results. Other ancillary tests may be indicated in cases of systemic involvement. In addition, serum alpha1 antitrypsin can be measured to demonstrate the association between nodular panniculitis and serum alpha1 antitrypsin deficiency. A better understanding of the etiopathogenesis of each of these interesting skin conditions necessitates extensive and systematic diagnostic approaches.

Mycobacterial Dermatitis

Mycobacterial skin disease in cats associated with atypical mycobacteria is an uncommon disease in small animal practice, and the disease is rarely encountered in dogs. A mycobacterial etiology should be considered in cases of chronic nodular dermatitis, draining tracts, and panniculitis. Cats and dogs affected with atypical mycobacterial infections are usually otherwise healthy, and systemic illness is unusual. In most cases, a diagnosis is made based on histopathological findings and growth of a causative organism. Group IV atypical mycobacteria can usually be grown following submission of affected tissue. Treatment should be based on antibiotic sensitivity test results. Treatment is prolonged and is unsuccessful in many cases. In cases of feline leprosy and canine leproid granuloma syndrome, organisms are difficult if not impossible to grow, and clinical and histopathological findings should be used to make a diagnosis. Spontaneous resolution of disease has been reported in atypical mycobacteriosis, feline leprosy, and canine leproid granuloma syndrome.

Treatment of relapsing idiopathic nodular panniculitis (Pfeifer-Weber-Christian disease) with mycophenolate mofetil

Idiopathic nodular panniculitis (Pfeifer-WeberChristian disease) is characterized by fever and symmetric subcutaneous nodules often located on the lower extremities.1,2 Histologically, a lobular panniculitis with a pronounced neutrophilic infiltrate is observed. The course of the disease is characterized by acute onset with fever and malaise and the simultaneous appearance of painful subcutaneous nodules. Some patients experience involvement of the intra-abdominal or retroperitoneal fat. Relapses are frequent, and a fatal outcome has been described repeatedly. Therapy usually consists of steroids in medium to high dosages, as well as immunosuppressive drugs such as azathioprine or methotrexate. Even with this treatment the disease tends to relapse and has an uncertain prognosis.

Panniculitis in tuberculosis: a clinicopathologic study of nodular panniculitis associated with tuberculosis.

Certain types of panniculitis, erythema induratum of Bazin and erythema nodosum, have been well documented as tuberculids. Many histopathologic diagnoses of panniculitis have been reported in tuberculosis patients. This study investigates the correlation between underlying tuberculosis and clinicopathologic findings of panniculitis. We retrospectively reviewed the clinical files of histologic-proven panniculitis cases at the Dermatologic Clinic, Siriraj Hospital from January 1992 to December 1995; only cases with active tuberculous foci were analyzed. The incidence of panniculitis caused by tuberculosis was 8.2%. The ratio of men to women was 1:1. The mean age of onset was 35.3 years. The average duration of the nodules was 35.5 days. There was a history of contact tuberculosis in 16.6%. Constitutional symptoms and a strongly positive purified protein derivative (PPD) reaction were found in 66.6%. Chest roentgenograms were abnormal in 83.3%. The erythrocyte sedimentation rate was elevated in all tested cases. The histopathologic diagnoses were nodular vasculitis (33.3%), erythema nodosum (50%), and cutaneous periarteritis nodosa (16.4%). The panniculitis lesion responded to standard antituberculous regimens in 4.6 weeks, on average, with residual hyperpigmentation. In panniculitis patients, clues for the investigation of tuberculosis included constitutional symptoms, elevated erythrocyte sedimentation rate, and abnormal chest roentgenograms. Histopathologic changes of panniculitis did not seem to correlate with underlying tuberculosis. The clinician should be aware of the tuberculosis, however, and should carefully search for active foci in all panniculitis patients.

Proptosis as the Manifesting Sign of Weber-Christian Disease

To identify proptosis as a manifesting sign of Weber-Christian disease (recurrent febrile nodular panniculitis). Case report. A 61-year-old man had signs of right proptosis and orbital inflammation that resolved with oral corticosteroid therapy. Orbital inflammation later recurred with associated cutaneous nodules, myalgia, nausea, and malaise. Rheumatologic evaluation and subcutaneous nodule biopsy led to the diagnosis of Weber-Christian disease. The patient required systemic immunosuppressive agents to control the disease. This case shows the rare finding of proptosis as the manifesting sign of Weber-Christian disease.

Sterile nodular panniculitis associated with lameness in a horse

Sterile nodular panniculitis associated with lameness in a horse

Panniculitis associated with pancreatic necrosis in a dog

ABSTRACTA seven‐year‐old male labrador cross was presented with lethargy, pyrexia and multiple nonpruritic draining skin lesions. The dog had sterile nodular panniculitis which, at necropsy, was found to be associated with a bile duct carcinoma leading to pancreatic necrosis.

Systemic nodular panniculitis in a patient with alpha-1 antitrypsin deficiency (PiSS phenotype)

The association of alpha-1 antitrypsin deficiency (PiZ phenotype) with systemic nodular panniculitis has been well documented. Despite reports of cases of systemic nodular panniculitis associated with other alpha-1 antitrypsin deficiency phenotypes, it is still not known if this association is fortuitous rather than causal. We report a case of systemic nodular panniculitis associated with alpha-1 antitrypsin deficiency (PiSS phenotype), with clinico-pathological features similar to those reported in cases associated with the PiZ phenotype.

Adult lipophagic atrophic panniculitis

We report two patients with chronic, recurrent, nodular panniculitis lesions that later developed areas of lipoatrophy. Histologically, there was a consistent lobular lipophagic replacement of fat cells with lipophagic giant cells. The clinical appearance was that of tender, erythematous, superficial or subcutaneous, symmetrical nodules and plaques of 1-2 weeks' duration. The lesions could occur with episodes of fever. One patient had hepatomegaly and the other had an increased sedimentation rate and leucocytosis. The histology and the clinical pattern of the panniculitus syndrome resembled those of lipophagic lipoatrophy of childhood. This is a panniculitis of unknown cause in which the principal inflammatory cell response in the subcutaneous tissue is the macrophage.

Sterile nodular panniculitis in five horses

Sterile nodular panniculitis in five horses

Nodular form of intra-abdominal panniculitis: sonographic features

Sonography of a patient with acute upper abdominal pain demonstrated an encapsulated hyperechoic mass which indented the stomach. Fine-needle biopsy produced atypical cells; the diagnosis of nodular intra-abdominal panniculitis was made at surgery. Sonography probably has a role in the detection and follow-up of this benign lesion.