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Rotondo C, Corrado A, Mansueto N, Cici D, Corsi F, Pennella A, Paolo Cantatore F. Pfeifer-Weber-Christian Disease: A Case Report and Review of Literature on Visceral Involvements and Treatment Choices. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2020; 13:1179547620917958. [PMID: 32528225 PMCID: PMC7263116 DOI: 10.1177/1179547620917958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 03/17/2020] [Indexed: 01/26/2023]
Abstract
Pfeifer-Weber-Christian disease (PWCD) is a rare idiopathic disease characterized by lobular panniculitis of adipose tissue with systemic symptoms and multiple organ involvement. Even though the systemic involvement is rare, it is life-threatening and represent a treatment challenge for the clinicians. We report a case of PWCD characterized by hepatic, hematologic, and renal involvement, with good response to mofetil mycophenolate and prednisone treatment. A 47-year-old female presented several months’ history of painful subcutaneous nodules, fever and lymphadenopathy with recent appearing of microcytic hypochromic anemia, leucopenia with neutropenia, and increase in transaminase. Skin biopsy showed lobular panniculitis with lymph-histiocytic and neutrophilic infiltrates with necrosis of adipocytes. A combination therapy of corticosteroid with mofetil mycophenolate was effective. Moreover, we discuss the clinical manifestation and the therapeutic choices in PWCD, from classical immunosuppressive drugs to new biotechnological agents, and we provide a comprehensive review of the available literature.
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Affiliation(s)
- Cinzia Rotondo
- Rheumatology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Addolorata Corrado
- Rheumatology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Natalia Mansueto
- Rheumatology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Daniela Cici
- Rheumatology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Fabrizio Corsi
- Unit of Pathology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Antonio Pennella
- Unit of Pathology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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2
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Somalanka S, Udo I, Nair H, Baikunje S. Pfeifer-Weber-Christian disease and successful treatment with mycophenolate mofetil: a case report. BMJ Case Rep 2019; 12:12/5/e229167. [PMID: 31122958 DOI: 10.1136/bcr-2018-229167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Inflammatory conditions manifest with a broad spectrum of signs and symptoms. Panniculitis is such a condition affecting the subcutaneous fat and presents as tender erythematous nodules. It is also associated with a systemic response and has been described in the literature as early as in 1892 by Pfeifer and in the 1920s by Weber and Christian. We present an unusual case of a Caucasian man with recurrent febrile illness, systemic inflammatory response and renal dysfunction requiring acute high dependency care. The authors successfully treated him with an antiproliferative agent, mycophenolate mofetil, which resulted in preventing him from having further episodes.
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Affiliation(s)
- Subash Somalanka
- South West Thames Renal & Transplantation Unit and South West Thames Institute for Renal Research, Saint Helier Hospital, Carshalton, Surrey, UK
| | - Ini Udo
- General Medicine, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Hari Nair
- Renal Medicine, Glan Clwyd Hospital, Rhyl, Denbighshire, UK
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3
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Broe PJ, Kelly CJ, Bouchier-Hayes DJ. Systemic Weber–Christian Disease with Portal Hypertension and Oesophageal Varices. J R Soc Med 2018; 81:669-70. [PMID: 3210203 PMCID: PMC1291853 DOI: 10.1177/014107688808101122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- P J Broe
- Department of Surgery, St Laurence's Hospital, Dublin, Ireland
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4
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Turner-Warwick R, Nabarro JDN, Doniach D. Riedel's Thyroiditis and Retroperitoneal Fibrosis. Proc R Soc Med 2016. [DOI: 10.1177/003591576605900704] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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5
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Adamama-Moraitou KK, Prassinos NN, Galatos AD, Tontis DK, Rallis TS. Isolated abdominal fat tissue inflammation and necrosis in a cat. J Feline Med Surg 2008; 10:192-7. [DOI: 10.1016/j.jfms.2007.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2007] [Indexed: 11/16/2022]
Abstract
This report describes a rare clinical case of a 4.5-month-old, female domestic shorthair, cat with isolated abdominal fat tissue inflammation and necrosis, resembling human omental panniculitis. Its possible relationship with pancreatitis or bile induced chemical peritonitis is also discussed. The overall clinical course was considered benign. Initial clinical signs were vomiting and anorexia, presumably due to inflammation, followed by mass development. It was speculated that, eventually, the kitten was vomiting because of mechanical pressure from the mass, and that this pressure subsided as the kitten grew. The mass was surgically resected and no relapse was evident during the next 4 years.
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Affiliation(s)
- Katerina K. Adamama-Moraitou
- Companion Animal Clinic (Medicine), Faculty of Veterinary Medicine, Aristotle University of Thessaloniki, 11 St Voutyra Street, 54627 Thessaloniki, Greece
| | - Nikitas N. Prassinos
- Companion Animal Clinic (Surgery and Obstetrics), Faculty of Veterinary Medicine, Aristotle University of Thessaloniki, 11 St Voutyra Street, 54627 Thessaloniki, Greece
| | - Apostolos D. Galatos
- Clinic of Surgery, Faculty of Veterinary Medicine, University of Thessaly, PO Box 199, 43100 Karditsa, Greece
| | - Dimitris K. Tontis
- Laboratory of Pathology, Faculty of Veterinary Medicine, University of Thessaly, PO Box 199, 43100 Karditsa, Greece
| | - Tim S. Rallis
- Companion Animal Clinic (Medicine), Faculty of Veterinary Medicine, Aristotle University of Thessaloniki, 11 St Voutyra Street, 54627 Thessaloniki, Greece
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6
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Trendelenburg M, Hess C, Kondo-Oestreicher M, Tissot JD, Späth P, Schifferli JA. Monomeric Complement-Activating IgG Paraproteins. THE JOURNAL OF IMMUNOLOGY 1999. [DOI: 10.4049/jimmunol.163.12.6924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Abstract
Three patients presented a unique syndrome of recurrent panniculitis with an IgGκ paraprotein and depletion of the early components of the classical pathway of complement. The IgGκ paraproteins were monomers with a normal structure, and with no evidence for aggregation, as assessed by electron microscopy and ultracentrifugation. Both heavy and light chains were of normal molecular size (SDS-PAGE), and the paraproteins were not heavily glycosylated. However, the paraproteins from all three patients had unusual features that included abnormal behavior on gel filtration chromatography and a heavy chain of high pI. When analyzed by fast protein liquid chromatography (Superdex 200), elution of the paraproteins was retarded, particularly when the ionic strength was increased. This retardation was partially reversed in 20% alcohol, and fully reversed in 6 M guanidine-HCl. Neither anti-C1 inhibitor nor anti-C1q autoantibodies were found in any of the patients’ sera. However, the paraproteins bound to the globular heads of C1q at normal ionic strength. They activated C4 in normal human serum, but not in C1q-deficient serum. Activation led to the formation of C1s-C1 inhibitor complexes. Taken together, the data suggest that the unusual paraproteins have the capacity to bind C1q, which then leads to activation of C1. The ability of these paraproteins to activate C1, in spite of their being soluble monomers, is likely to be related to their unique physicochemical features.
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Affiliation(s)
- Marten Trendelenburg
- *Immunonephrology Laboratory, Department of Research, University Hospital, Basel, Switzerland
| | - Christoph Hess
- *Immunonephrology Laboratory, Department of Research, University Hospital, Basel, Switzerland
| | | | - Jean D. Tissot
- ‡Blood Transfusion Center, University Hospital, Lausanne, Switzerland; and
| | - Peter Späth
- §Zentrallaboratorium Blood Donor Service, Bern, Switzerland
| | - Jürg A. Schifferli
- *Immunonephrology Laboratory, Department of Research, University Hospital, Basel, Switzerland
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7
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Ashizawa K, Hayashi K, Minami K, Mori M. CT and MR findings of posterior mediastinal panniculitis. J Comput Assist Tomogr 1997; 21:324-6. [PMID: 9071311 DOI: 10.1097/00004728-199703000-00032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A case of posterior mediastinal panniculitis is reported. CT and MRI showed a paraspinal mass containing a small amount of fat. The intercostal veins were found to run through the mass without being distorted, mimicking lymphoma. The diagnosis of panniculitis was made by CT-guided biopsy and open biopsy.
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Affiliation(s)
- K Ashizawa
- Department of Radiology, Nagasaki University School of Medicine, Japan
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8
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Abstract
This article reviews the most common clinical conditions presenting with fever and musculoskeletal symptoms and attempts to categorize these disorders according to general etiologic categories as an aid to differential diagnosis. Although a substantial armamentarium of serologic, immunologic, and molecular laboratory studies have been developed and are available to the clinician, the most important data are obtained from a careful history and physical examination with emphasis on the musculoskeletal system.
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Affiliation(s)
- S E Carsons
- Division of Rheumatology, Allergy and Immunology, Winthrop-University Hospital, Mineola, New York, USA
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9
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Heseltine D, Bramble M, Cole A, Clarke D, Castle W. Weber-Christian disease producing splenic vein occlusion and bleeding gastric varices: successful treatment with sclerotherapy. Postgrad Med J 1990; 66:321-5. [PMID: 2385562 PMCID: PMC2429406 DOI: 10.1136/pgmj.66.774.321] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A 48 year old woman with intra-abdominal Weber-Christian disease presented with bleeding gastric varices and evidence of splenic vein occlusion. We describe the problems encountered in making this diagnosis and subsequent treatment.
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Affiliation(s)
- D Heseltine
- Middlesbrough General Hospital, Cleveland, UK
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10
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Abstract
The clinical and pathologic features of six examples of nonnecrotizing granulomatous angiopanniculitis (GAP) of the breast are reported. The patients presented with a solitary ill-defined breast mass causing clinical suspicion of carcinoma. Histopathologically, all lesions consisted of multiple nonnecrotic, noncaseous granulomas with a giant cell component predominantly involving the subcutaneous adipose tissue, extending into the underlying mammary tissue without affecting lobules or ducts. A nonleukocytoclastic lymphocytic angiitis involved small vessels and capillaries. None of the patients had a history of an autoimmune disorder or had previous diagnoses of erythema nodosum or multiforme, leukocytoclastic or nonleukocytoclastic vasculitis, or Weber-Christian disease. Treatment was limited to biopsy in all six patients. Studies for infectious agents on specimens were negative. Five of the six patients developed one or more recurrences in the breast or elsewhere on the body. Four patients experienced spontaneous regression of their recurrent lesions. GAP appears to be a self-limited disorder of uncertain etiology which involves the breast and other sites. It may represent a variant of Weber-Christian disease, as the two diseases share similar clinical and histologic features. GAP must be distinguished from causes of granulomatous inflammation of the breast for which specific medical therapy is available.
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Affiliation(s)
- E S Wargotz
- Department of Breast and Gynecologic Pathology, Armed Forces Institute of Pathology, Washington, DC
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11
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Brawn LA, Ramsay LE, Shortland JR, Williams JL. Systemic Weber-Christian disease with reversible bilateral ureteric obstruction. Postgrad Med J 1989; 65:410-6. [PMID: 2608584 PMCID: PMC2429349 DOI: 10.1136/pgmj.65.764.410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
It has been proposed that idiopathic retroperitoneal fibrosis may be a consequence of 'healed' retroperitoneal lesions of systemic Weber-Christian disease. However ureteric obstruction which is the hallmark of idiopathic retroperitoneal fibrosis, has not been described in systemic Weber-Christian disease. We report a patient with systemic Weber-Christian disease who, during a relapse, developed bilateral ureteric obstruction which resolved when the Weber-Christian disease remitted. The radiological appearances were consistent with a diagnosis of idiopathic retroperitoneal fibrosis, but the clinical course was slightly atypical in that the ureteric obstruction resolved completely and rapidly. Ureteric obstruction can complicate systemic Weber-Christian disease and this observation gives support to the hypothesis that idiopathic retroperitoneal fibrosis is related to systemic Weber-Christian disease.
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Affiliation(s)
- L A Brawn
- University Department of Therapeutics, Royal Hallamshire Hospital, Sheffield, UK
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12
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Paniculitis de Weber-Christian con alteraciones radiográficas pulmonares. Arch Bronconeumol 1989. [DOI: 10.1016/s0300-2896(15)31772-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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13
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Steininger H, Missmahl M. Weber-Christian panniculitis with systemic cytophagic histiocytosis. KLINISCHE WOCHENSCHRIFT 1988; 66:365-72. [PMID: 3392893 DOI: 10.1007/bf01735796] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A 49-year-old woman suffered from Weber-Christian panniculitis with a typically periodic course. Subsequently, the attacks of the disease developed to a severe state: high fever, endotoxinemia, pancytopenia, and clotting disorder, in addition to the cutaneous manifestations. One and a half years after the outbreak of the disease the patient died in a septic shock. At autopsy all three stages of Weber-Christian panniculitis were found. In addition, an immense proliferation of benign cytophagic histiocytes could be observed in the bone marrow, spleen, lymph nodes and, less distinctly, in the fatty and interstitial tissues of the visceral organs. As a nosologic entity, the Weber-Christian disease is frequently questioned. Some authors consider the lobular, histiocytic, cytophagic panniculitis a unique syndrome. On the other hand, it must be emphasized that benign, cytophagic histiocytosis may exist associated with infections or may accompany different diseases. Furthermore, the Weber-Christian panniculitis is clinically and morphologically well defined.
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Affiliation(s)
- H Steininger
- Pathologisches Institut, Universität Erlangen-Nürnberg
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14
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Lemley DE, Chun B, Cupps TR. Sterile splenic abscesses in systemic Weber-Christian disease. Unique source of abdominal pain. Am J Med 1987; 83:567-70. [PMID: 3661591 DOI: 10.1016/0002-9343(87)90773-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A patient with Weber-Christian disease and relapsing abdominal pain due to sterile splenic abscesses is presented. Histologically, acute and chronic inflammation with focal suppurative infiltrates of phagocytosed fat was detected in the absence of vascular or embolic disease, infection, or other apparent cause. Abdominal discomfort, an uncommon manifestation of Weber-Christian disease, usually is related to mesenteric panniculitis. Sterile splenic abscesses represent a previously undescribed complication of Weber-Christian disease, and another source of abdominal pain in this disorder. Although the precise pathophysiology of sterile splenic abscess formation in Weber-Christian disease is unknown, splenectomy is an effective means of alleviating pain.
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Affiliation(s)
- D E Lemley
- Department of Medicine, Georgetown University School of Medicine, Washington, D.C. 20007
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15
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Abstract
Fat necrosis was present in 22 of 400 cases of consecutive postperinatal mortalities investigated to assess the presence and pattern of deep fat necrosis. In just over 50% of the cases of fat necrosis the cause of death was categorised as sudden infant death syndrome, which also showed more severe degrees of necrosis. The mechanism of necrosis may be vascular hypoperfusion, possibly related to shock, and brown adipose tissue, on account of its high metabolic activity and rich capillary plexus, may be particularly vulnerable to infarction. The occurrence of fat necrosis in association with other causes of death did not provide any definite clue as to the nature of the alleged shock.
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Affiliation(s)
- T J Stephenson
- Department of Histopathology, Children's Hospital, Western Bank, Sheffield
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16
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Walsh N, Towers RP, McCabe M. Systemic Weber-Christian disease with pancreatic and adrenal invasion. Ir J Med Sci 1985; 154:406-8. [PMID: 4077458 DOI: 10.1007/bf02937192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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17
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Vassall JH. Weber-Christian panniculitis with immune complex glomerulonephritis. J Natl Med Assoc 1985; 77:237, 241-3. [PMID: 3157006 PMCID: PMC2561865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The etiology of Weber-Christian panniculitis is unknown. A case is presented in which an association is found between immune complex glomerulonephritis and a relapse of Weber-Christian panniculitis. This case adds to the literature, implicating immune system dysfunction in the pathophysiology of this disease.
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Abstract
The Weber-Christian syndrome (relapsing nodular panniculitis) displays a clinical spectrum varying from short, self-limited, or intermittent disease episodes to persistent disease with fatal outcome. Inflamed adipose tissue is exclusively subcutaneous in some patients and is both subcutaneous and perivisceral in others. Inflammation of fat may induce a focal cutaneous or a systemic extracutaneous histiocytic proliferative response in which hemophagocytosis may be a frequent characteristic. Major causes of death--sepsis, hepatic failure, hemorrhage, and thrombosis--are identical in the patients with and without the systemic histiocytic proliferation. Inflammation in fat, of and by itself, may be associated with significant morbidity and mortality, regardless of specific histopathology or inciting factors.
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 21-1984. A 10-year-old girl with periodic episodes of abdominal pain and fever. N Engl J Med 1984; 310:1374-81. [PMID: 6717509 DOI: 10.1056/nejm198405243102108] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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20
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D'Amico G, Cirro G, D'Amico A. Classificazione Delle Fibrosi Retroperitoneali E Fisiopatologia Della Malattia Di Ormond (). Urologia 1983. [DOI: 10.1177/039156038305000640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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21
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 17-1982. Fever and subcutaneous masses in an elderly man. N Engl J Med 1982; 306:1035-43. [PMID: 7062995 DOI: 10.1056/nejm198204293061708] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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22
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Marston S. Wegener's Granulomatosis. J R Soc Med 1982; 75:274-6. [PMID: 7069697 PMCID: PMC1437635 DOI: 10.1177/014107688207500414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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23
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Ciclitira PJ, Wight DG, Dick AP. Systemic Weber-Christian disease: a case report with lipoprotein profile and immunological evaluation. Br J Dermatol 1980; 103:685-92. [PMID: 7459264 DOI: 10.1111/j.1365-2133.1980.tb01694.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A case of fatal systemic Weber-Christian disease is described. In vitro immunological function and lipoprotein measurements are presented with a subsequent discussion on the possible aetiology of the condition.
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Abstract
A case of mesenteric panniculitis is presented, with a review of previous reports.
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Mangiardi JR, Rappaport ZH, Ransohoff J. Systemic Weber-Christian disease presenting as an intracranial mass lesion. Case report. J Neurosurg 1980; 52:134-7. [PMID: 7350274 DOI: 10.3171/jns.1980.52.1.0134] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
A case is reported in which systemic Weber-Christian disease presented as a dural mass causing the signs and symptoms of increased intracranial pressure. The literature and possible pathogenesis of this entity are discussed.
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Kastendieck H, Hüsselmann H. [Xanthofibrogranulomatosis. Classification, localization, morphology, pathogenesis (author's transl)]. VIRCHOWS ARCHIV. A, PATHOLOGICAL ANATOMY AND HISTOLOGY 1978; 380:237-59. [PMID: 153041 DOI: 10.1007/bf00430461] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
A case of systemic Weber-Christian disease, involving retroperitoneal adipose tissue with secondary damage to the associated organs and blood vessels is reported. The involved organs showed varying degrees of necrosis, lipogranulomata and fibrosis.
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Abstract
A review of Weber-Christian syndrome in infancy is presented along with the report of two cases. Both infants had low serum properdin levels, and one patient showed remissions of his disease when he was T-lymphocytopenic. This suggests that the T-lymphocyte may have an important role in the pathogenesis of Weber--Christian syndrome.
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31
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Miyasaki K, Ooiso Y, Nakamura I, Oimomi M, Tai T, Saito K. An unusual case which began with subcutaneous panniculitis followed by fever, severe hepatic involvement and hyperlipidemia. ACTA PATHOLOGICA JAPONICA 1977; 27:213-24. [PMID: 871084 DOI: 10.1111/j.1440-1827.1977.tb01870.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A 25-year-old man was at first dermatologically suspected as suffering from Weber-Christian syndrome because of subcutaneous panniculitis, but his skin lesions disappeared completely during the course. Hyperlipidemia, disturbances in liver function, and leukemoid reaction became remarkable and he died of subarachnoid hemorrhage eleven months after onset. Necropsy revealed subarachnoid hemorrhage at the base of the brain, lipogranulomatous and inflammatory lesions in the upper lobe of the left lung, a remarkable fatty liver, splenomegaly, pericarditis, and foam cells in the spleen, liver, and bone marrow. A comparison with 57 autopsy cases of Weber-Christian syndrome reported in the literature showed our case to be an exceptional instance of Weber-Christian syndrome, if the present case is not to be regarded as a different disease entity.
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Abstract
We present 3 cases of a rare syndrome of extrinsic ureteral obstruction produced by retroperitoneal fat necrosis and compare the medical records and histopathology to 19 cases of classic idiopathic retroperitoneal fibrosis. Clinical similarities include average age of onset in the fourth and fifth decades, male preponderance, abdominal or back pain as the presenting symptom, elevation of the blood urea concentration prior to diagnosis and tendency toward bilateral involvement. Histologically, the 2 conditions were different. Retroperitoneal fat necrosis is characterized by coalescence of fat cells into fat cysts bordered by foreign body giant cell granulomas, foam cells, light chronic inflammatory infiltrate and unimpressive fibrosis. The microscopic pathology of idiopathic retroperitoneal fibrosis is dominated by densely collagenized fibrous tissue of varying cellularity without evidence of fat necrosis. Of the 3 cases of retroperitoneal fat necrosis 2 featured prior ischiorectal abscesses and this is considered in a discussion of the etiology of this unusual cause of ureteral compression.
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Abstract
A case is described of Weber-Christian panniculitis accompanied by a gammaglobulin disturbance which preceded by five years the diagnosis of an autoimmune hepatitis and pancytopenia. Also associated was the onset of diabetes mellitus, found at necropsy to be related to pancreatic islet amyloid deposition. This case reinforces the view that Weber-Christian panniculitis may be an adipose response to a variety of immunological stimuli.
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Abstract
A case of systemic nodular panniculitis is described in which the myocardium was found at necropsy to be extensively involved with focal interstitial carditis, identical histologically with nodules of panniculitis biopsied from the skin. This degree of myocardial involvement, which was not apparent during life and was not confined to pericardial or myocardial adipose tissue, has not previously been reported. The literature relating to nodular panniculitis is briefly reviewed and the concept of Weber-Christian disease critically re-appraised.
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35
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McCabe WP, Kelly AP. Soft tissue defects in Weber-Christian disease. BRITISH JOURNAL OF PLASTIC SURGERY 1974; 27:107-11. [PMID: 4817141 DOI: 10.1016/0007-1226(74)90071-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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37
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Rao CR, Ferguson GC, Kyle VN. Retroperitoneal fibrosis associated with Riedel's struma. CANADIAN MEDICAL ASSOCIATION JOURNAL 1973; 108:1019-21. [PMID: 4699273 PMCID: PMC1941367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
A case of retroperitoneal fibrosis with bilateral ureteral obstruction in association with Riedel's struma of the thyroid is reported. There has been a definite increase in incidence of retroperitoneal fibrosis, but with prompt recognition and adequate treatment the mortality rate has been decreased from the original 14%. The association of Riedel's struma with retroperitoneal fibrosis has been noted in the past and its association with sclerosing cholangitis has also been mentioned. It is not known whether Riedel's thyroiditis originates in the thyroid gland and spreads or whether true thyroiditis is part of a generalized process. The temporal relationship of thyroiditis and retroperitoneal fibrosis suggests an extension of fibrosis from the thyroid, but one cannot be sure which condition occurred first. Whatever the cause, the treatment remains the same as for retroperitoneal fibrosis from other causes.
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Binder SC, Deterling RA, Mahoney SA, Patterson JF, Wolfe HJ. Systemic idiopathic fibrosis. Report of a case of the concomitant occurrence of retractile mesenteritis and retroperitoneal fibrosis. Am J Surg 1972; 124:422-30. [PMID: 5056907 DOI: 10.1016/0002-9610(72)90057-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Hirokawa K, Nishido T, Okuda M. Post-steroid panniculitis with cerebral vascular and pulmonary complications--report of an autopsy case. ACTA PATHOLOGICA JAPONICA 1972; 22:565-79. [PMID: 4405007 DOI: 10.1111/j.1440-1827.1972.tb01853.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Pourfar M, Stiefel FH, Bearman J. Weber-Christian disease: a general review based on observations in a five-year-old Negro girl. Clin Pediatr (Phila) 1968; 7:600-4. [PMID: 5682376 DOI: 10.1177/000992286800701011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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41
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Abstract
A case of combined idiopathic mediastinal fibrosis and retroperitoneal fibrosis is described. It is possibly the twelfth case to be reported during life. A review of the literature reveals the `ubiquity' of localized collagenosis and the trend of opinion as regards aetiology and treatment.
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Turner-Warwick R, Nabarro JD, Doniach D. Riedel's thyroiditis and retroperitoneal fibrosis. Proc R Soc Med 1966; 59:596-8. [PMID: 5939497 PMCID: PMC1900982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Abstract
Idiopathic retroperitoneal fibrosis is represented as one of the manifestations of a widespread disease, systemic idiopathic fibrosis. Some evidence is presented which suggests its origin as an inflammatory disease of adipose tissue. Although relatively rare, the idiopathic diseases of adipose tissue and its blood vessels are worthy of closer study.
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