Panniculitides of particular interest to the rheumatologist

Abstract

The panniculitides remain as one of the most challenging areas for clinicians, as they comprise a heterogeneous group of inflammatory diseases involving the subcutaneous fat with potentially-shared clinical and histopathological features. Clinically, most panniculitides present as red edematous nodules or plaques. Therefore, in addition to a detailed clinical history, a large scalpel biopsy of a recent-stage lesion with adequate representation of the subcutaneous tissue is essential to specific diagnosis and appropriate clinical management. Herein we review the panniculitides of particular interest to the rheumatologist.

Viral panniculitis in a patient with disseminated opportunistic Enterovirus infection

“…First, a distant focus of viral infection can trigger panniculitis via immune system derangement or a hypersensitivity reaction. For example, erythema nodosum has been associated with cytomegalovirus (CMV), herpes simplex virus, or EBV infections, among others 3‐5 . A second mechanism involves a virus or treatment thereof giving rise to systemic changes that pathophysiologically set the stage for a different form of panniculitis.…”

“…For example, pancreatic panniculitis can occur in acute pancreatitis associated with triple therapy of chronic hepatitis C infection 9 . This mechanism can be further exemplified by bacterial or fungal panniculitis occurring in the setting of immunodeficiency due to human immunodeficiency virus (HIV) infection 2,3 …”

“…Most cases of infection‐induced panniculitis occur on the lower extremities as a predominantly lobular panniculitis; however, mixed or predominantly septal panniculitis can also occur. Infection‐induced panniculitis poses a diagnostic challenge, because of its rarity, relatively non‐specific clinicopathologic presentation, and need for additional diagnostic studies 1‐3 …”

Lobular panniculitis in rheumatic diseases: the authors’ own data

“…Представляет большой интерес нозологическая принадлежность видов и вариантов Пн при ревматических заболеваниях (РЗ). Нередко в качестве одного из симптомов РЗ выступают Пн, которые могут являться причиной поздней диагностики основного заболевания [6]. Особую значимость представляет ЛПн при РЗ.…”

“…Нередко Пн ассоциируется с РЗ [6]; так, при СКВ он встречается в 1-5% случаев [4,13,14], при системных васкулитах -в 0,5-1% [15], при ССД -в 8% [14,16], при ДМв 10% [14,17], при болезни Бехчета -в 25-50% [4,9]. Истинная клиническая и прогностическая значимость Пн при РЗ остается недооцененной.…”