No abstract

Dermatopathologists rarely greet a biopsy of panniculitis with total confidence that a specific, definitive diagnosis will be rendered. As with many other areas in dermatopathology, our understanding of the pathogenesis of many forms of panniculitis is incomplete. This article examines a subset of panniculitis primarily from a pathogenetic standpoint, with the intention of providing a differential diagnosis for those cases in which ischemic changes are seen in the subcutis. The diverse group of conditions evoked by this approach also shares the distinction of having been the focus of nosologic and causative controversy, both historically and currently. In particular, stasis-associated sclerosing panniculitis, vascular calcification-cutaneous necrosis syndrome (calciphylaxis), oxalosis, and nodular vasculitis-erythema induratum are examined in depth. Erythema nodosum and variants, other granulomatous panniculitides, and panniculitides showing cytophagocytosis are also discussed with current perspectives.

Bacillary angiomatosis, an infectious process associated with Rochalima spp., was thought until recently to be restricted to HIV-infected or otherwise immunosuppressed patients. In 1993, bacillary angiomatosis was reported in several immunocompetent adults. An extensive literature review failed to find references to bacillary angiomatosis in immunocompetent children. We describe a 6-year-old female who presented with a single, rapidly growing, friable, erythematous papule on her neck. Histologic examination of a biopsy specimen confirmed the diagnosis of bacillary angiomatosis. The patient was otherwise healthy, and her physical examination was normal. Laboratory studies, including HIV serology, were normal. The patient was treated with six weeks of oral erythromycin without evidence of recurrence. We present and discuss the implications of the first case of bacillary angiomatosis in an immunocompetent child.

Because extracorporeal photopheresis has been shown to be clinically effective in Sezary syndrome, a disease characterized by a circulating malignant clone, we initiated a pilot study of its use in B-cell chronic lymphocytic leukemia (B-CLL) to see if it could be similarly effective. We treated three patients with Rai stage III and IV B-CLL with photopheresis (3 consecutive days a week every 3 weeks) and followed serial clinical and immunologic parameters. While we noted no major toxicity, there was neither clinical response to treatment nor marked improvement in white counts or mitogen assays. We conclude that photopheresis was not effective in inducing remission in this pilot study of advanced stage B-CLL patients.