Panniculitis In Patients Research Articles

Association between mesenteric panniculitis and urolithiasis.

Mesenteric panniculitis is a rare condition and refers to benign and nonspecific inflammation of mesenteric fat. This study aimed to evaluate the hypothesis of a greater prevalence of mesenteric panniculitis in patients with urolithiasis. In this cross-sectional study, abdominopelvic CT scans of 500 patients were reviewed for the presence of urolithiasis and mesenteric panniculitis. The inclusion criteria were patients who were referred with acute abdominal pain and were suspected of having urolithiasis or other urinary conditions and who had undergone abdominopelvic CT scan. Subcutaneous fat thickness was measured, and pain intensity was recorded by patient evaluation. Mesenteric panniculitis was found in 10 patients, all of whom (100%) had urinary stones (ureter or kidney or both), and none of them had previous surgeries or known malignancies. The prevalence of panniculitis was significantly greater in the group with urolithiasis. In the urolithiasis group, subcutaneous fat thickness was greater in patients with panniculitis, although the difference was not statistically significant. In the subgroup analysis, pain intensity was not significantly greater in patients with panniculitis. Mesenteric panniculitis is more prevalent among patients with urolithiasis, but it seems that it does not change the intensity of the pain.

BRAF inhibitor-induced panniculitis in patients treated for stage IV metastatic melanoma: a case series

BRAF and MEK inhibitor combination therapy is the standard treatment for patients with BRAF V600E mutant metastatic melanoma. Neutrophilic panniculitis is a known rare complication of BRAF inhibitor therapy and can act as a potential mimic of melanoma metastases on 18F-FDG PET/CT. In this case series, we present three cases of BRAF inhibitor-induced panniculitis in patients being treated for BRAF-mutant metastatic melanoma and emphasize the use of ultrasound to differentiate between panniculitis lesions, which are typically ill-defined echogenic masses and subcutaneous soft tissue melanoma metastases, which present as hypoechoic vascular masses.

Panniculitis in Cutaneous Leishmaniasis: a Study in Sri Lanka

Introduction: Panniculitis is the inflammation of subcutaneous adipose tissue which is caused by many infectious and inflammatory conditions. It is high time to document panniculitis in the skin lesions with cutaneous leishmaniasis (CL) in Sri Lanka. Objectives: This study was performed to assess demographic data and to describe panniculitis in patients with CL. Methods: A descriptive cross-sectional study was done from 2013 to March 2018 at Teaching Hospital Kandy, Sri Lanka. The skin biopsies clinically suspected as CL evaluated histologically for diagnostic or indicative evidence of CL, and patients responded completely to the specific anti-leishmaniasis treatment were taken as the study population. Skin biopsies of 123 patients were assessed in view of dermal granulomata, Leishman-Donovan bodies and panniculitis. Results: The majority of patients were in the age group of 36 to 50 years (N= 36:29.3%: mean=41.64 years: SD18.15 years) and there was a slight female predominance in the study (N=65:52.8%). A majority of skin biopsies revealed Granulomata (N=95: 77.2%). Leishmania Donovan bodies were identified among 43.1% of the lesions (N=53). Though there were 123 patients, only 66 (53.6%) skin biopsies were deeper enough to reveal subcutaneous tissue. A significant amount of skin lesions showed subcutaneous tissue inflammation (N=59:89.39%), predominantly non-granulomatous in morphology (N=44:74.6%). Conclusion: Subcutaneous tissue inflammatory infiltrates in the non-granulomatous morphology is an important feature of the skin biopsies of CL especially in the granulomatous variant of the CL, which can be achieved by a deeper elliptical biopsy.

Calcifying Lupus panniculitis in patients with No manifestations of Systemic Lupus Erythematosus

Lupus panniculitis named also as lupus profundus is characterized by one or several firm subcutaneous nodules with or without overlying epidermal changes (Figure 1). Sometimes, lupus profundus is manifestated by erhytematosus plaques, some deep plaques and nodules ulcer involving the extremities, trunk, breasts, buttocks or face. Lupus paniculitis is considered a variant of lupus erythematosus cutaneous that primarily affects subcutaneous tissue [1]. Lesions appear while other may resolve slowly or may have long standing calcification.

Panniculitis in patients treated with BRAF inhibitors: a case series.

Panniculitis is a rare complication of BRAF inhibitor therapy that is used to treat patients with BRAF-mutated metastatic melanoma. We present a clinicopathologic review of 9 patients who developed panniculitis while on BRAF inhibitor therapy. In 13% of patients on vemurafenib, 3% of patients on dabrafenib and 10% on combination of dabrafenib + trametinib, tender erythematous nodular lesions of panniculitis appeared on legs, arms and trunk. Histological evaluation of 8 biopsies from 7 patients showed predominantly neutrophilic infiltrate in 4, lymphocytic in 1, and mixed in 3. Lesions with neutrophilic infiltrate appeared in earlier stages of treatment than those with mixed or lymphocytic infiltrate. All biopsies showed lobular involvement and 5 also had a septal component. In addition, 1 biopsy had lichenoid inflammation in the epidermis and the other had evidence of vasculitis. Most patients responded to conservative medical management without the need to reduce or to stop BRAF inhibitor therapy. Panniculitis seems to be a rare class effect of BRAF inhibitors that is predominantly lobular and neutrophilic, although other patterns can be seen.

Subcutaneous Sweet syndrome in the setting of myeloid disorders: A case series and review of the literature

The association of neutrophilic dermatoses with myeloid disorders is well known, but neutrophilic panniculitis in the same setting has only been reported infrequently. We aimed to better characterize these lesions clinically and histologically, and to provide a comprehensive differential diagnosis and appropriate diagnostic approach. The pathology archives were searched for cases of neutrophilic panniculitis in patients with myeloid disorders. Clinical history and histologic features were studied. Similar cases in the English-language literature were reviewed. Five biopsy specimens from 4 patients and 11 previous case reports were identified. All patients presented with erythematous tender nodules typically involving the extremities. Most were accompanied by fevers, and resolved either spontaneously or with steroids. Histologically, the subcutaneous neutrophilic infiltrates demonstrated lobular or, less frequently, septal patterns with minimal dermal involvement. Leukocytoclasis, fat necrosis, reactive stromal fibroblasts, and mild reticular dermal edema were each seen in at least 3 of our 5 biopsy specimens. No myeloid blasts, vascular changes, or non-Miescher granulomas were observed. No micro-organisms were identified in the skin nodules. This study is limited by the small number of cases. Based on the fairly consistent clinical and histologic findings, neutrophilic panniculitis occurring in the setting of myeloid disorders is best classified as subcutaneous Sweet syndrome after exclusion of infectious panniculitis, id reaction, and leukemia cutis. These lesions may be associated withmyeloid disorders, or induced by chemotherapy or other medications.

Vemurafenib-induced neutrophilic panniculitis

Vemurafenib is a targeted therapy, used in patients with metastatic cutaneous melanoma who carry the BRAF V600E mutation, with a relative reduction of 63% in the risk of death. Several adverse events have been described previously, such as photosensitivity or squamous-cell carcinomas. Two cases of panniculitis have been reported recently with two different selective BRAF inhibitors. We report two cases of neutrophilic panniculitis in patients treated by vemurafenib for a metastatic melanoma. Clinical and biological examinations showed no indications for an immune nor an infectious cause of neutrophilic panniculitis. Thus, we believe that vemurafenib caused this panniculitis. Treatment with vemurafenib was maintained in both patients because of the clinical and radiological tumoral responses. One patient showed spontaneous recovery, whereas the other patient presented several recurrences of panniculitis. We believe that physicians should be aware of this cutaneous side effect of vemurafenib, but it should not lead to discontinuation of this treatment.

Connective tissue panniculitis: lupus panniculitis, dermatomyositis, morphea/scleroderma

Panniculitis is an uncommon cutaneous manifestation of connective tissue diseases. Our discussion will include panniculitis occurring in the setting of lupus erythematosus, dermatomyositis, and scleroderma/morphea. These subtypes of panniculitis are unified by an active inflammatory stage of the disease that can progress to develop scarring, atrophy, and calcifications. Treatment is most effective if initiated during the active phase of the disease and often requires systemic therapy because of the location of the inflammation. Antimalarials are the initial treatment of choice for most cases of lupus erythematosus panniculitis, whereas corticosteroids in combination with other steroid-sparing immunosuppressive agents are the first-line treatment for panniculitis in patients with dermatomyositis. The appropriate treatment for panniculitis in the setting of morphea/scleroderma varies based on clinical severity.

Panniculitis With Histiocytoid/Immature Neutrophils is Not Limited to Histiocytoid Panniculitic Sweet Syndrome

To the Editor: Dr. Chow et al have recently reported a series of patients with infiltrates of immature neutrophils involving either the dermis or subcutis. Cases involving the subcutis were referred to as subcutaneous histiocytoid Sweet syndrome. Whereas we have also made the diagnosis of histiocytoid Sweet syndrome in patients with immature infiltrates of neutrophils involving the dermis, we advise caution in the use of this term in those cases with immature neutrophils involving the subcutis, for a variety of reasons. Just as our understanding of panniculitis over the last decades has revealed Weber-Christian to be a wastebasket term consisting of a variety of previously poorly understood panniculitidies, neutrophilic infiltrates, whether consisting of mature or immature cells in the panniculis, may be seen with a variety of panniculities and do not necessarily warrant a diagnosis of Sweet or histiocytoid Sweet syndrome. In response to the report from Cohen1 in 2004 on subcutaneous Sweet syndrome, we reported the importance of excluding alpha-1-antitrypsin panniculitis, which can present as a neutrophilic panniculitis in patients with no other systemic signs of alpha-1-antitrypsin disease.2,3 Additionally, Thurber and Kohler4 have reported a neutrophilic dense pattern of erythema nodosum. Neutrophilic lobular panniculitis can also be seen in the infectious variant of neutrophilic eccrine hidradenitis. Pancreatic panniculitis may show mostly neutrophils without saponification and ghost cells in the earliest stages. Many of the reports on subcutaneous panniculitic T cell lymphomas have also mentioned prominent neutrophilic infiltrates masking the lymphomatous cells.5 Also important, patients with inflammatory bowel disease may frequently have subcutaneous neutrophilic infiltrates. Further, poststeroid panniculitis, which is often granulomatous, may also have dense neutrophils. Additionally, in our experience, patients with subcutaneous infiltrates of neutrophils rarely meet all the criteria for Sweet syndrome. Hence, just as in patients with subcutaneous infiltrates of mature neutrophils, when evaluating a patient with subcutaneous infiltrates of immature neutrophils, it is important to exclude the above-mentioned possibilities, and histiocytoid Sweet syndrome should be a diagnosis of exclusion. Pedram Gerami, MD Joan Guitart, MD Northwestern University Feinberg School of Medicine, Chicago, IL

Dermatomyositis: the Asia-Pacific perspective

Dermatomyositis: the Asia-Pacific perspective

Sclerosing panniculitis is associated with pulmonary hypertension in systemic sclerosis

There have been no reports of patients with sclerosing panniculitis and systemic sclerosis (SSc). To evaluate the incidence of sclerosing panniculitis in patients with SSc, and to investigate the clinical features of such cases. In total, 128 patients with SSc treated at our clinic were investigated retrospectively. SSc patients with sclerosing panniculitis had pulmonary hypertension (PH), especially isolated PH, at a significantly higher incidence than those without. Among the SSc patients with PH, those with sclerosing panniculitis had pulmonary infarctions at a higher incidence than those without. Our results suggest that thrombosis caused by venous hypertension of the leg may be the main cause of PH in patients with SSc and sclerosing panniculitis. Sclerosing panniculitis may be a useful marker of PH in patients with SSc.

Neutrophilic tuberculous panniculitis in a patient with polymyositis

The clinical spectrum of cutaneous M. tuberculosis infections is varied and atypical. Once a major cause of death, with the advent of antimicrobial drugs it had, until recently, been an uncommon consideration in the differential diagnosis of cutaneous disorders. Panniculitis can be caused by a variety of etiologic agents; however, only rarely has it been reported caused by tuberculosis. Herein, we describe a patient with an unusual case of neutrophilic panniculitis caused by M. tuberculosis that arose following corticosteroid therapy for presumptive polymyositis. This case illustrates the need to include mycobacterial infection in the differential diagnosis of panniculitis in immunocompromised patients, and the importance of early detection via microbiologic culture and histopathologic examination.

Intra-abdominal panniculitis can mimic recurrent stomach carcinoma

Carcinoma of the stomach is increasingly treated with chemotherapy. We describe two cases of intra-abdominal panniculitis in patients after laparotomy and chemotherapy for stomach carcinoma. Intra-abdominal panniculitis can result in mass lesions in the mesentery and omentum. The diagnosis should be considered in patients who have undergone chemotherapy for stomach carcinoma and who develop abdominal masses.