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Maniam GB, Coakley A, Huong Nguyen G, Alavi A, Davis MDP. Neutrophilic Panniculitides. Dermatol Clin 2024; 42:285-295. [PMID: 38423687 DOI: 10.1016/j.det.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Neutrophilic panniculitides are a heterogeneous group of inflammatory disorders encompassing many different entities. This review article focuses on the epidemiology, pathogenesis, clinicopathological features, diagnosis, and treatment of selected diseases. Patients often seek care due to systemic involvement, but the variable presentation of panniculitides can present a diagnostic challenge. Most therapeutic modalities for neutrophilic disorders are anecdotal at best with a notable lack of standardization of the responses to medications. There is an urgent need for a larger multi-institutional collaboration to address the unmet needs of these challenging, yet rare conditions.
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Affiliation(s)
- Ganesh B Maniam
- Mayo Clinic Department of Dermatology, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Anne Coakley
- Mayo Clinic Department of Dermatology, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Giang Huong Nguyen
- Mayo Clinic Department of Dermatology, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Afsaneh Alavi
- Mayo Clinic Department of Dermatology, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Mark D P Davis
- Mayo Clinic Department of Dermatology, 200 First Street Southwest, Rochester, MN 55905, USA
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Borges T, Silva S. Panniculitis: A Cardinal Sign of Autoinflammation. Curr Rheumatol Rev 2024; 20:350-360. [PMID: 37921131 DOI: 10.2174/0115733971254702231020060633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 08/19/2023] [Accepted: 09/01/2023] [Indexed: 11/04/2023]
Abstract
Panniculitis was first described in the nineteenth century and is characterized by inflammation of the subcutaneous fat. It may be categorized in septal or lobular subtypes, but other histopathological features (e.g., presence of vasculitis, nature of inflammatory infiltrates, characteristics of fat necrosis) are also important for diagnostic purposes. Clinically, panniculitis is characterized by the presence of subcutaneous nodules, and both ulcerative and nonulcerative clinical subtypes have been proposed. In this review, we aimed to describe the occurrence of panniculitis in autoinflammatory disorders (AIDs) and related diseases. Among monogenic AIDs, panniculitis is common in IFN-mediated disorders. Panniculitis is a distinctive feature in proteasome-associated autoinflammatory syndromes (PRAAS), including chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature (CANDLE) syndrome and Nakajo-Nishimura syndrome. On the other hand, erythema nodosum corresponds to the most common clinical form of panniculitis and is common in polygenic AIDs, such as Behçet's syndrome, inflammatory bowel disease, and sarcoidosis. Cytophagic histiocytic panniculitis, lipoatrophic panniculitis of children, and otulipenia are rare disorders that may also present with inflammation of the subcutaneous fat. Therefore, panniculitis can identify a specific subgroup of patients with AIDs and may potentially be regarded as a cardinal sign of autoinflammation.
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Affiliation(s)
- Tiago Borges
- Trofa Saúde Gaia, Rua Fernão de Magalhães nº 2 Fr E, 4404-501 Vila Nova de Gaia, Portugal
| | - Sérgio Silva
- Trofa Saúde Gaia, Rua Fernão de Magalhães nº 2 Fr E, 4404-501 Vila Nova de Gaia, Portugal
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Seguí M, Rodríguez-Jiménez P, Fraga J, Navas J, Ríos JJ, Revilla D, Santos-Briz Á, Lluch JJ, Fernández Figueras MT, Luque M, Llamas Velasco M. Pancreatic panniculitis revisited: A series of 34 patients. J Cutan Pathol 2023; 50:983-990. [PMID: 37605438 DOI: 10.1111/cup.14515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 05/02/2023] [Accepted: 07/31/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Pancreatic panniculitis is a rare form of panniculitis generally associated with acute or chronic pancreatitis, and less frequently with pancreatic carcinoma. Clinically, it presents with subcutaneous nodules usually located in the lower extremities, however, it presents an almost pathognomonic histopathological finding with enzymatic fat necrosis in the adipose tissue. METHODS In this retrospective case series of five hospitals, biopsy specimens of cutaneous lesions of pancreatic panniculitis were reviewed. Clinical information was obtained through medical records. RESULTS A total of 34 cases were included, 23 women and 11 men, aged between 31 and 92 years. The most common associated pancreatic disease was acute pancreatitis (23 cases) and its main triggering cause was gallstones (17 cases). In two patients it was related to chronic pancreatitis and six cases were associated with malignancy. Histopathological findings were always the key to diagnosis. In the biopsies reviewed, mostly lobular panniculitis with the characteristic necrosis of the adipocytes was observed. In addition, nine of the cases presented with Splendore-Hoeppli phenomenon. CONCLUSIONS We present the largest series of pancreatic panniculitis. Clinically, the female predominance and biliary lithiasis as the main cause of acute pancreatitis are to be emphasized. Histopathologically, a peripheral eosinophilic striated rim surrounding aggregates of ghost adipocytes consistent with Splendore-Hoeppli is an additional clue to its diagnosis.
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Affiliation(s)
- Mireia Seguí
- Department of Dermatology, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Javier Fraga
- Department of Pathology, Hospital Universitario de La Princesa, Madrid, Spain
| | - José Navas
- Department of Dermatology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Juan José Ríos
- Department of Pathology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - David Revilla
- Department of Dermatology, Hospital Clínico Universitario, Salamanca, Spain
| | - Ángel Santos-Briz
- Department of Pathology, Hospital Clínico Universitario, Salamanca, Spain
| | - Juan José Lluch
- Department of Dermatology, Hospital Universitari Germans Tries y Pujol, Barcelona, Spain
| | - María Teresa Fernández Figueras
- Head of Surgical Pathology Area, Pathology Department, Sant Cugat del Valles, Hospital Universitari General de Catalunya, Spain
| | - Mar Luque
- Department of Dermatology, Hospital Clínic, Barcelona, Spain
| | - Mar Llamas Velasco
- Department of Dermatology, Hospital Universitario de La Princesa, Madrid, Spain
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Cohen AJ, Gleason LK, Bhatti SA, Nikbakht N. Neutrophilic panniculitis associated with myelodysplastic syndrome/myeloproliferative neoplasm: a case report and literature review. INTERNATIONAL JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2023; 6:168-171. [PMID: 37811487 PMCID: PMC10552795 DOI: 10.1097/jd9.0000000000000286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Introduction Neutrophilic panniculitis (NP) is a rare subtype of neutrophilic dermatosis, a group of neutrophil-rich inflammatory skin disorders that can present in association with myeloid neoplasms. NP is defined by the presence of a neutrophilic infiltrate in the fat lobules of the subcutis in the absence of either infection or vasculitis. We herein describe a 65-year-old woman with a recent diagnosis of myelodysplastic syndrome/myeloproliferative neoplasm overlap syndrome (MDS/MPN) who abruptly developed painful, pruritic nodules consistent with NP. Case presentation A 65-year-old woman with MDS/MPN presented for evaluation of painful and pruritic nodules on her upper and lower extremities. A biopsy revealed a lobular neutrophilic infiltrate in the subcutis without evidence of microorganisms or vasculitis. The patient was diagnosed with NP and treated with oral prednisone. Within 1 month of treatment, she reported complete resolution of the nodules. Discussion Similar to other neutrophilic dermatoses, NP may arise in association with hematologic malignancies of myeloid origin, such as MDS/MPN. A literature review revealed that most cases of NP associated with MDS occur after the onset of MDS and respond to systemic corticosteroids, not antibiotics. Infection should be ruled out before initiating treatment with systemic steroids. Conclusion Although the mechanism is still unknown, it is important for clinicians to be aware that NP is associated with MDS; thus, hematological malignancies should be investigated upon diagnosis of NP. Once diagnosed, NP is easily treated and has an excellent response to systemic corticosteroids.
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Affiliation(s)
- Alexa J. Cohen
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Laura K. Gleason
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Safiyyah A. Bhatti
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
- Department of Hematology & Oncology, Thomas Jefferson University, Philadelphia, PA
| | - Neda Nikbakht
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
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Mazeda C, Aguiar R, Fernandes B, Barcelos A. Tender cutaneous nodules of the legs-What is the diagnosis? Int J Rheum Dis 2022; 25:1444-1445. [PMID: 36066381 DOI: 10.1111/1756-185x.14432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 08/15/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Carolina Mazeda
- Rheumatology Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal.,Centro Académico Clínico Egas Moniz, Aveiro, Portugal
| | - Renata Aguiar
- Rheumatology Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal.,Centro Académico Clínico Egas Moniz, Aveiro, Portugal
| | - Bárbara Fernandes
- Dermatology Department, Instituto Português de Oncologia, Coimbra, Portugal
| | - Anabela Barcelos
- Rheumatology Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal.,Centro Académico Clínico Egas Moniz, Aveiro, Portugal.,NOVA National School of Public Health, Public Health Research Center, NOVA University of Lisboa, Lisbon, Portugal.,Comprehensive Health Research Center, NOVA University of Lisboa, Lisbon, Portugal
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Anand NC, Takaichi M, Johnson EF, Wetter DA, Davis MDP, Alavi A. Suggestions for a New Clinical Classification Approach to Panniculitis Based on a Mayo Clinic Experience of 207 Cases. Am J Clin Dermatol 2022; 23:739-746. [PMID: 35849324 DOI: 10.1007/s40257-022-00709-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Panniculitis, or inflammation of adipose tissue, includes a heterogeneous group of disorders with similar morphologic presentations. Currently, panniculitides are classified based on histopathologic findings only. OBJECTIVE In this retrospective study of 207 cases of biopsy-proven panniculitis over 20 years at Mayo Clinic, we aimed to propose a new classification that integrates the clinical morphologic features with the histopathology of panniculitis. METHODS We collected patient demographic and lesion morphologic characteristics using lesion photographs and physician notes for each of our 207 cases, including location, ulceration, scale, pattern (unilateral versus circumferential), atrophy/sclerosis (cicatricial), redness, and swelling. RESULTS The panniculitides most likely to ulcerate were calciphylaxis (85.7% ulcerating), pancreatic panniculitis (66.6%), and α1-antitrypsin deficiency-associated panniculitis (100%). The panniculitides least likely to ulcerate were erythema nodosum and medication-induced and granulomatous panniculitis. This retrospective study used only descriptions in clinical notes and available medical photographs. CONCLUSION We present an updated classification schema of panniculitides based on clinical findings. The primary distinctions are based on ulceration, location, and number of lesions. Although complete distinction of all panniculitides based on clinical examination alone is not possible, we hope the proposed schema allows clinicians to tailor differential diagnoses.
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Affiliation(s)
| | | | - Emma F Johnson
- Department of Dermatology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - David A Wetter
- Department of Dermatology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Mark D P Davis
- Department of Dermatology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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