Musculoskeletal manifestations with panniculitis - a hospital based study on 62 patients in Kuwait

Abstract

The study describes 62 patients seen over a period of 4 years mainly presenting with an acute inflammatory ankle arthritis/periarthritis associated with panniculitis. Based upon the clinical characteristics of panniculitis two distinct categories could be defined. These included patients with characteristic lesions of erythema nodosum, seen in 51 (82%), the idiopathic form in 29 (57%), and secondary EN in 22 (43%). Associated conditions included Behçet's disease, oral contraceptive pills, pregnancy and penicillin treatment. Patients clinically not having typical EN was seen in 11 (18%). In this group the histopathology showed erythema induratum in 4, cutaneous-polyarteritis nodosa with minimal panniculitis in 3, Weber-Christian disease, cytophagic histiocytic panniculitis, and 'mixed' lobular and septal variety of panniculitis in 1 each. (In 1 patient the disease was not panniculitis but cutaneous variant of granuloma annulare). It is concluded that in a hospital setting EN associated with acute musculoskeletal symptoms, mainly ankle arthritis/periarthritis or an acute peripheral polyarthritis, was a common rheumatological problem in Kuwait. However, other forms of panniculitides also presented with musculoskeletal manifestations requiring accurate histopathological diagnosis for appropriate treatment.

Weber‐Christian disease presenting with lung nodules dramatically improved with corticosteroid therapy: one case report and literature review

“…It is suggested that T-cell immune response is involved in the pathogenesis of WCD. [2][3][4] In our patient, histochemistry staining showed lymphocytic cells in endobronchitis. Comparing tocyclosporine A, cyclophosphamide can decrease both T cell and B cell functions and replication.…”

“…Previous case reports showed cyclosporine A can be effective to resolve fever and painful subcutaneous nodules, and it can decrease high serum concentrations of interferon‐gamma and soluble interleukin‐2 in WCD patients. It is suggested that T‐cell immune response is involved in the pathogenesis of WCD . In our patient, histochemistry staining showed lymphocytic cells in endobronchitis.…”

“…1,2 It is also known as idiopathic relapsing febrile lobular nonsuppurative panniculitis and characterized by recurrent subcutaneous inflammatory painful nodules, fever and malaise due to systemic inflammation. [2][3][4] In severe cases, the inflammation can involve the lung, heart, gastrointestinal tract, spleen, kidney and adrenal gland. However, the prognosis of WCD is extremely variable.…”

Panniculitis in childhood and adolescence

“…Weber–Christian disease is the most serious form of panniculitis, with systemic manifestations, and has been only exceptionally described in the pediatric age group 1,24–28 . Seventy‐five percent of the cases occur in women after the second decade of life 26,29 .…”

Pfeifer-Weber-Christian Disease and Benign Multiple Subcutaneous Noninfiltrative Angiolipomas: A Puzzling Case and Review of a Rare Entitety

“…Lipophagia and granulomas led to confusion in the context of erythema nodosum, but focal necrosis of fat cells is not typical for it [3]. Erythema nodosum has been classi ed as predominantly septal panniculitis, unlike ndings in PWCD being classi ed as lobular panniculitis [10,11].…”