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Pyogranulomatous panniculitis due to infection by Mycobacterium smegmatis was diagnosed in two cats in Finland, a country with a rather cold climate. The diagnosis was confirmed by sequencing of the 16S rRNA gene, which gave a perfect match with the M smegmatis strain ATCC 19420. Gene sequencing makes it possible to distinguish M smegmatis from closely related mycobacteria such as M goodii sp.nov. Diagnosing this entity seems to be a question of having a high index of suspicion. The appearance of the disease as well as sampling is described in detail. In our first case an initial erroneous diagnosis of Nocardia species considerably delayed our arriving at the right diagnosis. The first patient has now been followed for more than 7 years. Her disease is chronic, but she is not systemically affected. Several antimicrobials were tried. Probable side effects of enrofloxacin medication are described.

Brucellosis is a common world-wide zoonotic disease. Cutaneous manifestations are not specific and affect 1-14% of patients with brucellosis. We describe two cases of young males presenting with skin lesions of erythema nodosum on the anterior surface of the legs. Histopathology of skin biopsy revealed septal panniculitis, but the positive cultures of blood or bone marrow for Brucella melitensis established the diagnosis of brucellosis.

A 13-year-old, male cocker spaniel presented with a history of inappetence, depression and reluctance to stand. The dog had multiple, ulcerated skin lesions which were diagnosed as panniculitis by histopathology. A diagnosis of pancreatitis was made on the basis of markedly elevated serum lipase concentrations, abdominal ultrasonography which showed an abnormal lobulated area of hypoechoic tissue in the body and right lobe of the pancreas, and a fine needle biopsy from this area which revealed large numbers of degenerate neutrophils. After treatment with antibiotics and prednisolone, the dog made a full clinical recovery and was free of clinical signs for four months. The dog was euthanased five months later and postmortem examination revealed chronic, active pancreatitis and a pancreatic adenoma. This is the first report of antemortem diagnosis of pancreatitis and panniculitis in a dog.

Severe panniculitis caused by alpha1-antitrypsin deficiency is very rare even though the ZZ phenotype occurs in 1 : 3500 of the population of northern Europe. We describe a 33-year-old woman with rapidly progressing panniculitis and extensive skin necrosis with multiple life-threatening complications. Initial treatment followed by maintenance therapy with human purified enzyme (Prolastin, Bayer, Bridgend, U.K.) has been life-saving.

Panniculitis is a relatively rare condition, which is usually treated non-operatively. We present a case of panniculitis causing an acute septicaemic episode and threatening the integrity of underlying joint prostheses. The situation was salvaged by radical debridement of the affected areas, and reconstruction using split-skin grafts. Considerations in the management of patients with this condition are discussed.

Panniculitis and lipodystrophy are rare disorders of subcutaneous tissue. Recently the incidence of lipodystrophy has been increasing secondary to its appearance in patients with HIV. In this population, the lipodystrophy appears to be a direct consequence of drug therapy. A review of the available literature regarding pathogenesis and treatment options is discussed. The diagnosis of panniculitis has been hampered by problems. The recent literature has concentrated on ways of improving pathologic diagnostic yields, and new aids in diagnosis are presented.

Objectives: To describe the clinical and pathologic features of panniculitides, an uncommon group of diseases, where the available Indian literature is sparse., Material and Methods: Prospective four years study of patients presenting with panniculitis to a large teaching hospital in North India., Results: Erythema nodosum (EN) was the commonest panniculitis (79.3% cases) in our cohort. Other causes included erythema induratum, Weber Christian disease, cutaneous polyarteritis nodosa and panniculitis associated with Takayasu's arteritis and dermatomyositis-lupus overlap. Elevated ESR and leukocytosis were the common laboratory abnormalities encountered. Septal panniculitis without vasculitis was the most frequent histopathologic pattern observed. Patients of EN did well on nonsteroidal anti-inflammatory drugs while corticosteroids with or without azathioprine were used to treat other panniculitides., Conclusions: Physician awareness, clinical pattern recognition and histopathological confirmation, all play a key role in the identification and management of panniculitis.

Specific and nonspecific panniculitis sometimes occurs during the course of connective tissue diseases. However, the association of panniculitis and dermatomyositis (DM) has only rarely been described. Previous reports have suggested that panniculitis may be an inherent part of DM but, because the cases reported are few, it is difficult to know the significance of this unusual association. We describe 2 patients with DM in whom panniculitis developed during the course of the disease, and discuss its clinical and diagnostic significance.

A 45-year-old female patient discussed herein had a multifocal, alopecia areata of inflammatory character. Histological findings first suggested histiocyte cytophagic panniculitis, although a "burned-out" panniculitis-like T-cell lymphoma could not be excluded. After a two-year follow-up period assessment of the T-cell receptor gene rearrangement verified the diagnosis of subcutaneous panniculitis-like T-cell lymphoma. This case is interesting because of its isolated manifestation and a long-standing, benign course of the disease.

Background: Interferons are used in the immune therapy of multiple sclerosis, Kaposi's sarcoma, hepatitis and melanoma based on their antiviral, immunoregulatory and antitumor activities. We report a rare side effect observed during treatment of multiple sclerosis with subcutaneous interferon beta injections., Observations: A 44-year-old patient diagnosed with multiple sclerosis received immune therapy with 6 Mio IU recombinant interferon-beta (IFN-beta) every other day. After 4 years of subcutaneous interferon injections painful indurations appeared directly at and adjacent to the injection sites on the thighs, arms and abdomen. Pain in the thighs made walking almost impossible and required therapy with opiates. After changing to another interferon-beta medication the symptoms improved. Subsequent treatment with doxycycline for 3 weeks was of no additional benefit., Conclusions: Panniculitis at the injection sites is a rare event but has a significant impact on the quality of life during interferon therapy.

Pancreatic panniculitis is a rare complication that occurs in 0.3-3% of patients with pancreatic diseases. Most of the cases reported to date were associated with adenocarcinoma and acute or chronic pancreatitis. We here present an 88-year-old man who was admitted to our institution with a nonfunctional neuroendocrine carcinoma of the pancreas. He subsequently developed pancreatic panniculitis and arthritis. Treatment with octreotide did not have an effect neither on progression of the carcinoma nor on development of new skin lesions. Two months after the diagnosis of pancreatic panniculitis had been made, the patient died from progressing carcinoma. A review of the literature shows that there is no congruent hypothesis for the pathogenesis of pancreatic panniculitis. Vascular damage seems to induce lipolysis by pancreatic enzymes. This eventually leads to fat necrosis. The diversity of disorders that can go along with pancreatic panniculitis suggests an unspecific damage of pancreatic tissue as a first step in the chain of events., (Copyright 2002 S. Karger AG, Basel)

Eosinophilic panniculitis is characterized by a prominent infiltration of subcutaneous fat with eosinophils. The clinical spectrum of lesions that display pathologic changes of eosinophilic panniculitis is diverse, but nodular lesions are the most common. The factitial eosinophilic panniculitis are exceptional, show a pleomorphic pattern of findings and are associated with personality disorders. Its main challenge is to establish the correct diagnostic. We report an unusual case of factitial nodular febrile panniculitis of the left forearm and proximal arm in an 16 year-old girl. She admitted that the lesions were self-inflicted by autoinjection of several farming products as attempted suicide. We describe the clinical, radiological and histopathological features as well as the differential diagnosis of this type of panniculitis.

Background: Pancreatic panniculitis is a rare complication of pancreatic disease. Histopathologic findings are pathognomonic and may be helpful for early diagnosis., Methods: We present a female kidney transplant recipient, with systemic lupus erythematosus on immunossuppresive therapy, who developed panniculitis., Results: Histological features strongly suggested pancreatic panniculitis and this was confirmed by clinical, laboratory and image findings., Conclusion: The characteristic histologic features of pancreatic panniculitis may help to uncover undiagnosed pancreatic disease. Early therapy may avoid ensuing serious complications.

Background: Cutaneous findings other than hyperpigmentation are rare in Whipple's disease., Case Report: We present the case of a 59-year-old man previously diagnosed with Whipple's disease by duodenal biopsy, who developed red-brown, painful, subcutaneous nodules on the buttocks, thighs, arms and legs. Biopsy of these nodules showed a septal panniculitis and foamy macrophages containing PAS-positive, diastase resistant intracytoplasmic material, characteristic of Whipple's disease and similar to that observed in the duodenal biopsy. Ultrastructurally, this material in the histiocytes corresponded to degenerated bacilli., Conclusions: This is the fourth documented case of subcutaneous involvement by Whipple's disease. One should consider the possibility of Whipple's disease in any patient who presents with symptoms compatible with that condition who demonstrates septal panniculitis with a large amount of foamy histiocytes.

A small proportion of patients with alpha1-antitrypsin (alpha1AT) deficiency experience recurrent ulcerating panniculitis. Studies suggest that alpha1AT-deficiency panniculitis reflects an uncontrolled inflammatory process because of the serum's incapacity to neutralize proteolytic enzymes released by leukocytes in the skin. Dapsone is considered the treatment of choice for this entity, but it is limited by its side effects, especially hematologic ones. Tetracyclines have anticollagenase and anti-inflammatory activity and have been used successfully to treat this type of panniculitis. We report the case of a 42-year-old woman with recurrent alpha1AT-deficiency panniculitis who did not tolerate the side effects of dapsone or systemic corticosteroid. Minocycline treatment led to disappearance of lesions, and long-term administration prevented recurrences without evident negative side effects. We consider minocycline a safe treatment that allows control of alpha1AT-deficiency panniculitis.

Many reports have associated tuberculosis with haematological abnormalities. These reports suggest that severe pulmonary tuberculosis, if associated with reduced tissue cellular reaction, may cause blood discrasias. Anemia was present in 32 percent of patients. Leucopenia with neutropenia and lymphopenia was observed in 15 percent in patients with very severe clinical tuberculosis. Active tuberculosis was associated with significant reductions in absolute numbers of total T, T4 and B lymphocytes, but there were no significant differences in total T8 counts. T4 lymphopenia causes reversal of T4/T8 ratio. Also, many histopathologic diagnosis of panniculitis have been reported in tuberculosis patients--the incidence of panniculitis caused by tuberculosis was 8.2%. We present a case of secondary pulmonary tuberculosis with atypically Rx changes, associated with polyserositis and severe leucopenia, which debuted with a panniculitis.

Although rare, panniculitis and polyarthritis can be the presenting manifestations of pancreatitis. Early recognition of this triad is critical because of the high mortality rate from pancreatic disease when the diagnosis is delayed. We report a patient with chronic alcohol intake whose sole presentation was severe polyarthritis and skin lesions secondary to chronic pancreatitis associated with extra pancreatic pseudocyst. Both arthritis and skin lesions disappeared after partial pancreatectomy and pancreatic stent insertion for a pancreatic duct stricture.

A 23-year-old man, admitted because of high fever, polyarthralgia, butterfly rash and chest pain, was diagnosed as systemic lupus erythematosus (SLE) from the findings of positive antinuclear antibody and anti-DNA antibody. He was treated with 60 mg prednisolone daily, but as reducing the dose, white blood cell counts and platelet counts were decreased and fever, polyarthralgia, decrease of complements, increase of ferritin, hepato-splenomegaly and liver dysfunction were observed. Bone marrow specimen revealed phagocytosis of blood cells by histiocytes and he was diagnosed as hemophagocytic syndrome(HPS) due to active SLE. Methylprednisolone pulse therapy was effective temporarily, HPS recurred while reducing steroid, and cyclosporin was added. After a temporary remission, marked extensive swelling in the face appeared suddenly. Facial skin biopsy showed necrosis of fat cells and hemophagocytosis by histiocytes. Accordingly, he was diagnosed as panniculitis due to HPS and was treated successfully with intravenous cyclophosphamide pulse therapy and high dose of gammaglobulin. Several cases of HPS due to SLE have been reported recently, but this is a rare case of cytophagic histiocytic panniculitis (CHP) due to SLE.

Lechiguana is a disease of cattle characterized by large, hard, subcutaneous swellings that grow rapidly and result in death after 3-11 months in untreated animals. Cattle treated with antibiotics recover. The disease has been reported from five states in south and southeastern Brazil. Histologically, the lesion consists of focal proliferation of fibrous tissue infiltrated by plasma cells, eosinophils, lymphocytes and sometimes neutrophils. The primary lesion is an eosinophilic lymphangitis, which results in eosinophilic abscesses, with occasional rosettes containing bacteria in their centres. Much experimental and epidemiological evidence, reviewed in this article, supports the suggestion that lechiguana is caused by an association of Pasteurella granulomatis (syn: Mannheimia granutomatis) and Dermatobia hominis.

One of the common lesions in Crohn's colitis is erythema nodosum, a septal panniculitis that may appear before diagnosis or in conjunction with flare up. We report a case of Crohn's colitis where the presenting sign was neutrophilic lobular panniculitis with few granulomas. The possibility that this case represents a forme fruste of metastatic Crohn's is suggested. As skin biopsies are not usually performed by gastroenterologists in erythema nodosum-like skin lesions in Crohn's patients it may well be that the incidence of lobular panniculitis is higher than reported in the literature.

An 83-year-old Cambodian woman presented with multiple painful erythematous nodules on the lower legs, forearms and wrists. Subsequent history and investigations revealed a granulomatous lobular panniculitis associated with Sjögren's syndrome. This is a rare cutaneous association of Sjögrens syndrome with only three similar case reports in the literature.

Reports of equestrian perniosis are rare in the literature and in the cases previously described there have been no abnormal laboratory investigations. We describe two patients with equestrian perniosis who had persistently elevated titres of cold agglutinins. We discuss the relationship of these cold agglutinins to the pathogenesis of perniosis and other related skin disorders.

Eosinophilic panniculitis is characterized by a prominent infiltration of subcutaneous fat with eosinophils. We report a case of Fasciola hepatica infection presenting with eosinophilic panniculitis successfully treated with bithionol. To our knowledge, this is the first report of recurrent eosinophilic panniculitis associated with Fasciola hepatica infection.

Background: Cutaneous sclerosis, a process that results in hardening of the skin, is the hallmark of scleroderma and sclerodermoid disorders. Cutaneous sclerosis is usually classified as secondary or primary, depending on the presence or absence of underlying diseases. Primary cutaneous sclerosis is a feature of idiopathic inflammatory processes that are often associated with autoimmune disorders, whereas secondary cutaneous sclerosis arises in the context of many pathological processes of varying causes, including chronic graft-vs-host disease, defined metabolic or genetic disorders, and exposure to certain infectious organisms, drugs, or chemicals., Observations: Three patients had localized cutaneous sclerosis overlying the site of a surgically removed (stripped) great saphenous vein. In all 3 patients, lesions were clinically characterized by multiple hypopigmented and indurated plaques distributed linearly along the path of the preexisting vein. Extensive history, physical examination, and diagnostic tests did not reveal known predisposing factors for cutaneous sclerosis., Conclusions: Although the observed association of sclerodermiform dermatitis and venous stripping in these 3 patients does not imply a causal relationship, the absence of other identifiable predisposing factors and the striking linear distribution of the cutaneous lesions along the path of the preexisting vein are suggestive. This poststripping sclerodermiform dermatitis may be a rare late complication of saphenous vein stripping.

Panniculitis is a rarely reported clinical finding in dermatomyositis. We present a 14-year-old African American boy with a 4-year history of dermatomyositis referred for evaluation of tender, indurated plaques and nodules on the trunk and proximal extremities. A biopsy specimen revealed epidermal and dermal changes consistent with dermatomyositis. Although calcification was absent, a striking lobular panniculitis was observed. A total of seven cases of clinical panniculitis in association with dermatomyositis have been published. As in our patient, it typically presents as indurated, tender plaques and nodules on the arms, thighs, and buttocks. Although in the vast majority of cases panniculitis found in association with dermatomyositis is subclinical and represents an incidental histopathologic finding, the case we present further emphasizes the need to recognize panniculitis as a rare, but clinically relevant pathologic feature seen in certain lesions of juvenile dermatomyositis.

Rheumatoid nodules, which affect the subcutis around joints, are the most frequent specific cutaneous lesions of rheumatoid arthritis (RA). Panniculitis is a rarely reported and nonspecific complication of RA. We report a 42-year-old woman with seropositive RA who presented with a 2-month history of lower leg panniculitis. Biopsy of a leg nodule showed a lobular neutrophilic infiltrate with lipophages and central basophilic necrosis. In addition, focal changes of lipomembranous fat necrosis indicative of ischemic damage were identified at the margins of the lobular infiltrate. Neutrophilic lobular panniculitis is commonly detected in panniculitis secondary to bacterial infections, pancreatitis, and factitial causes. However, this pattern of panniculitis has also been reported in some cases of erythema nodosum-like lesions found in Behçet disease or bowel bypass syndrome and in rare cases of seropositive RA. These reported histologic findings fall into the spectrum of neutrophilic vascular reactions described by Jorizzo and Daniels for RA-associated dermatoses. In view of these findings. RA and related neutrophilic dermatoses (e.g., Behçet disease) should be included in the differential diagnosis of neutrophilic lobular panniculitis.

Scleroderma profunda represents an unusual clinical entity. There are no unified criteria for its diagnosis. Seven patients with scleroderma profunda were studied. The clinical features can be summarised in three groups: 1. hyperpigmented plaques with subcutaneous induration; 2. erythematous plaques with induration of the skin and subcutis; 3. pale indurated plaques with atrophy and sometimes ulcerobullous lesions. Histology showed sclerodermiform changes in the deep dermis and subcutis and vasculitis in one case. Dermal lymphocytic infiltration was well pronounced in 5 cases and consisted of predominantly CD3+ T cells. Differential diagnosis from panniculitis can be difficult. Mucin deposition was established in all cases.

Subcutaneous fat necrosis is a form of panniculitis associated with pancreatitis or pancreatic carcinoma. The massive release in the bloodstream of lipolytic enzymes such as lipase, amylase and trypsin causes these lesions. As pancreatic disease is often asymptomatic, extensive investigations are mandatory in the presence of panniculitic lesions to search for an underlying disease.

Lipoatrophia semicircularis is an apparently rare condition, which presents as semicircular band-like atrophy of the subcutaneous fatty tissue and involving half the circumference of the anterolateral aspects of the thighs. Repeated external microtraumatism seems to be the most plausible explanation in several cases in the literature, though in some patients the underlying traumatic mechanism is difficult to establish. No relation to underlying clinical or biologic abnormalities appears to be. Seven patients with lipoatrophia semicircularis are described. A detailed clinical history revealed precipitating trauma in all cases. A review is made of earlier reports in the literature.

The inflammatory diseases of the hypodermis represent a difficult problem both for the accurate diagnosis and treatment. Several distinct etiologies and pathomechanisms can be responsible for such lesions. We present an updated panniculitis classification.

Cold panniculitis is a form of physical panniculitis due to exposure of skin to severe cold. It usually appears on the cheeks of infants and children. It has also been reported on the thighs and buttocks of young females. Its clinical manifestations include red, cold, indurated plaques or nodules which appear one to three days after exposure to low temperatures and resolve spontaneously within several weeks without scarring. The histopathological picture shows a perivascular infiltrate of lymphoid and histiocytic cells at the dermal-subcutaneous junction in the early phase of the reaction (1). After 48 to 72 hours, a well developed panniculitis appears. We report an unusual case of an adult female patient with recurrent panniculitis on her legs appearing in the winter but without any preceding repeated or prolonged exposure to cold. She responded dramatically to oral tetracycline. This drug was successful as a prophylactic agent as well.

Background: 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., Methods: 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., Results: 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., Conclusions: 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.