ABSTRACT
Pancreatic panniculitis (PP) is a necrotizing inflammation of subcutaneous fat that is a rare complication of pancreatic disease appearing in 2% to 3% of all patients. It is more common in the elderly and often affects the extremities. It presents as skin inflammation with pain and erythema nodules. We report a case of acute pancreatitis associated with PP in an old female. She was admitted for vomiting and abdominal pain for 3 days and presented with a 2-week history of erythematous subcutaneous nodules on her legs. Laboratory and ultrasonic findings revealed acute pancreatitis. High frequency ultrasound showed hypoechoic foci in subcutaneous soft tissue layer and adipose layer. Histopathological examination confirmed the diagnosis of PP. Nodules disappeared with the resolution of acute pancreatic inflammation. PP may be the first manifestation of pancreatic disease. Imaging features of this pathology are seldom described and ultrasonic diagnosis experience is worth to be accumulated.
Subject(s)
Aged , Female , Humans , Acute Disease , Inflammation/complications , Pancreatic Diseases/diagnostic imaging , Pancreatitis/diagnostic imaging , Panniculitis/etiology , UltrasonographyABSTRACT
An assortment of clinical and laboratory abnormalities may occur as paraneoplastic syndromes in lymphomas. Rheumatological and dermatological manifestations such as paraneoplastic arthritis and pyoderma gangrenosum must be underscored. We report a 28 years old woman who developed pyoderma gangrenosum and two years later presented with arthritis of knees and ankles associated with panniculitis interpreted as erythema induratum that was pathologically confirmed. She developed a reactivation of pyoderma gangrenosum, that was refractory to treatment. Complementary studies showed a pulmonary nodule and a right paravertebral mass with involvement of the psoas muscle. Biopsies of both masses and a new pathological skin study demonstrated a large B-cell non-Hodgkin's lymphoma.
Subject(s)
Humans , Female , Adult , Paraneoplastic Syndromes/complications , Arthritis/etiology , Lymphoma, Non-Hodgkin/complications , Panniculitis/etiology , Pyoderma Gangrenosum/etiology , Paraneoplastic Syndromes/diagnosis , Paraneoplastic Syndromes/drug therapy , Arthritis/diagnosis , Lymphoma, Non-Hodgkin/diagnosis , Lymphoma, Non-Hodgkin/drug therapy , Panniculitis/diagnosis , Pyoderma Gangrenosum/drug therapyABSTRACT
El síndrome febril prolongado (SFP) se define en pediatría como la presencia de un episodio febril de al menos 7-10 días de evolución sin diagnóstico etiológico pese a un estudio inicial completo. La etiología más frecuente es la infecciosa, seguida por causas inmunoreumatológicas y neoplásicas. En la mayoría de los casos la evolución suele ser benigna y autolimitada, sin embargo una minoría presenta una causa subyacente con pronóstico sombrío, determinando necesidad de un estudio sistematizado. Objetivo: Presentar caso clínico de un escolar con SFP asociado a paniculitis y enfatizar importancia de estudio secuencial de SFP para pesquisar pacientes que requieren intervención oportuna. Caso clínico: Escolar de sexo masculino, 10 años de edad, previamente sano, quien consultó por cuadro de 2 meses de evolución, caracterizado por aparición de lesiones nodulares en abdomen y extremidades, poco sintomáticas, asociado a fiebre prolongada. Se hospitalizó para estudio, descartando causa infecciosa y reumatológica. Se confirmó diagnóstico de linfoma paniculítico de células T mediante biopsia y análisis histológico e inmunohistoquímico de las lesiones. Conclusiones: Al diagnosticar SFP se debe descartar causas más prevalentes (infecciosa) y luego plantear como diagnóstico diferencial etiología reumatológica y neoplásica. Si SFP se asocia a lesiones elementales nodulares, plantear precozmente la biopsia de modo de pesquisar potencial causa maligna y evitar retraso terapéutico.
Fever of unknown origin (FUO) is defined as fever over 7 to 10 days without a diagnosis despite a complete initial study. The most frequent causes are infections, autoimmune and tumors. Even though most cases are self-limited there is a minority that has an underlying etiology with an ominous forecast, encouraging a systematized study. Objective: To report a rare case of a boy who presented fever of unknown origin associated to panniculitis and was diagnosed of subcutaneous panniculitis-like-T cell lymphoma and to emphasis the importance of a sequential study of FUO, in order to reach a diagnosis in patients who need a timely intervention. Clinical case: A ten year old boy, previously healthy, presented subcutaneous nodular lesions of 2 month of evolution, located in abdominal region and extremities, given few symptoms, associated with prolonged fever. He was hospitalized for proper study, in first instance infectious and immune causes were discarded and through lesions biopsy the diagnose of subcutaneous panniculitis-like-T cell lymphoma was reached. Conclusion: When FUO is diagnosed, most prevalent causes must be discarded. Then, differential diagnosis, such as immune and neoplasic etiologies, have to be considered. If FUO is associated to elemental nodular lesions, biopsy must be indicated early, in order to find potential malignant cases, avoiding therapeutic delay.
Subject(s)
Humans , Male , Child , Panniculitis/etiology , Fever of Unknown Origin/diagnosis , Fever of Unknown Origin/etiology , Syndrome , Fever of Unknown Origin/complicationsABSTRACT
Resumo A doença de Chagas acarreta grande morbimortalidade, por parasitemia aguda ou por lesões cardíacas, digestivas, cutâneas ou neurológicas crônicas. Os países latino-americanos apresentam a maioria das pessoas infectadas ou em risco. Pacientes transplantados em uso de imunossupressores podem desenvolver formas graves da doença, muitas vezes fatais. As drogas disponíveis para o tratamento causam frequentemente efeitos colaterais graves. Uma paciente de 59 anos, com insuficiência renal crônica avançada e sorologia positiva para doença de Chagas, mas sem qualquer manifestação clínica dessa patologia, recebeu transplante renal de doador cadáver e apresentou três meses depois paniculite na coxa, tendo a biópsia das lesões mostrado formas amastigotas de Trypanosoma cruzi. Foi tratada com benzonidazol, observando-se o desaparecimento das lesões, mas a droga teve que ser suspensa por pancitopenia grave. Simultaneamente, apresentou infecção por E. faecalis e por citomegalovírus, tratadas com vancomicina e ganciclovir. Manteve-se depois muito bem clinicamente, sem novas lesões cutâneas e com boa função do enxerto. Um ano e três meses após o transplante, foi submetida à cirurgia de urgência por aneurisma dissecante da aorta. Evoluiu com choque irreversível e óbito no pós-operatório imediato. Não foi possível estabelecer ou afastar alguma relação entre as lesões aórticas e a tripanossomíase. A doença de Chagas deve ser lembrada no diagnóstico diferencial de várias situações clínicas em pacientes transplantados, principalmente em zonas endêmicas. Pode haver resposta clínica à medicação, mas são possíveis para-efeitos graves com as drogas utilizadas. O tratamento ou a profilaxia ainda aguardam por opções mais efetivas e melhor toleradas.
Abstract Chagas' disease carries high morbidity and mortality due to acute parasitemia or cardiac, digestive, cutaneous or neurologic chronic lesions. Latin American countries have the majority of infected or at risk people. Transplanted patients using immunosuppressive agents may develop severe and even fatal forms of the disease. The available treatment causes frequent severe side-effects. A 59 years-old woman with end stage renal disease and positive serology for Chagas` disease, but without any clinical manifestation of this pathology, underwent kidney transplantation from a cadaveric donor and displayed three months later a thigh panniculitis from which a biopsy unveiled amastigote forms of Trypanosoma cruzi. The skin lesions disappeared following treatment with benzonidazole, but the drug was discontinued due to severe pancytopenia. Along with this, infection with E. faecalis and cytomegalovirus were treated with vancomicin and ganciclovir. The patient kept very well afterwards, with no new skin lesions and with good graft function. One year and three months after the transplant, she had an emergency surgery for an aortic dissecting aneurysm. Irreversible shock and death occurred in the immediate post-surgical period. It was not possible to establish or to rule out a relationship between the trypanosomiasis and the aortic lesions. Chagas` disease must be remembered in differential diagnosis of several clinical situations in transplant patients, mainly in endemic areas. The treatment can yeld good clinical response, but serious side-effects from the drugs may ensue. More effective and better tolerated options are in need for treatment or prophylaxis.
Subject(s)
Humans , Female , Middle Aged , Panniculitis/etiology , Kidney Transplantation/adverse effects , Chagas Disease/complications , Immunosuppressive Agents/adverse effects , Trypanosoma cruzi , Chagas Disease/drug therapyABSTRACT
A paniculite pancreática, condição patológica rara, acomete 2-3 por cento dos pacientes com doença do pâncreas. Em 40 por cento dos casos, precede manifestações de doença pancreática. Relata-se caso de paciente feminina, 71 anos, surgimento há 1 mês de nódulos eritematosos nas pernas que evoluíram para ulceração e saída de conteúdo amarelado. Sem sintomas abdominais. A biópsia revelou macrófagos vacuolizados e necrose gordurosa representada por áreas anfofílicas, de material amorfo. Exame laboratorial e TAC demonstraram pancreatite crônica. Presume-se que a liberação de enzimas pancreáticas, tais como a tripsina, pode aumentar a permeabilidade da microcirculação e, então, a lípase e a amilase causariam a necrose de gordura subcutânea observada nas lesões. Na histologia, observam-se "células fantasmas" e paniculite septal de início e posteriormente lobular. O tratamento direciona-se a resolução da doença base.
Pancreatic panniculitis is a rare pathological condition affecting 2-3 percent of patients with pancreatic disease. In 40 percent of cases the condition precedes manifestations of pancreatic disease. We report the case of a 71-year-old female who presented with an erythematous tender node which had appeared one month previously, progressing to ulceration and yellowish exudation. No abdominal symptoms. Biopsy revealed fat necrosis and vacuolated macrophages represented by amorphous amphophilic areas. Laboratory examination and CT scan revealed chronic pancreatitis. It is assumed that release of pancreatic enzymes such as trypsin may enhance the permeability of the microcirculation leading to lipase and amylase causing the subcutaneous fat necrosis observed in the lesions. Histology showed "ghost cells" and, firstly, septal panniculitis, followed later by lobular panniculitis. Treatment focused on resolution of the underlying pancreatic disease.
Subject(s)
Aged , Female , Humans , Pancreatitis, Chronic/pathology , Panniculitis/pathology , Subcutaneous Fat/pathology , Necrosis/etiology , Necrosis/pathology , Pancreatitis, Chronic/complications , Panniculitis/etiologyABSTRACT
Lipomembranous panniculitis is a special type of fat necrosis which has been associated with several clinical conditions, mainly chronic venous insufficiency and connective tissue disorders such as lupus profundus, morphea, systemic sclerosis, and dermatomyositis .We report a 50 year old woman with known rheumatoid arthritis who presented with a painful indurated erythematous plaque on her right leg. Histologic examination demonstrated cystic areas of fat necrosis lined by wavy eosinophilic hyaline membrane with convoluted projections of the membrane into the cysts. This finding is diagnostic of lipomembranous panniculitis. To our knowledge, this is the first report on lipomembranous panniculitis associated with rheumatoid arthritis
Subject(s)
Humans , Middle Aged , Female , Panniculitis/etiology , Panniculitis/diagnosis , Biopsy , Arthritis, Rheumatoid , ComorbidityABSTRACT
La paniculitis neutrofílica (PN) asociada a síndrome mielodisplásico es una condición muy rara. Presentamos un paciente con PN como parte de una manifestación inicial de síndrome mielodisplásico (Leucemia promielocítica aguda). La PN aparece como una erupción nodular subcutánea, dolorosa, acompañada de síntomas sistémicos, cuyo estudio histopatológico evidencia un infiltrado neutrofílico lobular sin vasculitis, limitado al tejido subcutáneo. Debe ser diferenciada de otros tipos de dermatosis neutrofílicos y de otras hipodermitis lobulares. La PN se asocia significativamente a procesos mielodisplásicos y es altamente sensible al tratamiento con cortidoides sistémicos.
Subject(s)
Humans , Male , Adult , Panniculitis/diagnosis , Panniculitis/etiology , Panniculitis/pathology , Adrenal Cortex Hormones/therapeutic use , Leukemia, Promyelocytic, Acute/complications , Skin/pathology , Prednisone/administration & dosage , Prednisone/therapeutic use , Myelodysplastic Syndromes/immunology , Myelodysplastic Syndromes/pathologyABSTRACT
Los implantes dérmicos se utilizan en la corrección de arrugas, cicatrices, líneas de expresión y en el aumento de pómulos y labios, mientras que los subcutáneos, según los principios de la mesoterapia, intentan mejorar lipodistrofia y exceso de panículo. Se dispone en la actualidad de una amplia gama de productos naturales y sintéticos, los cuales son en general bastantes seguros. La mayor demanda de la población por procedimientos estéticos ha elevado la popularidad de estos implantes, los que muchas veces son ejecutados ilegalmente por personal no médico con productos no autorizados, lo que aumenta la frecuencia de efectos adversos.
Subject(s)
Humans , Injections, Subcutaneous/adverse effects , Skin/surgery , Prostheses and Implants/adverse effects , Collagen/adverse effects , Panniculitis/etiology , Silicones/adverse effectsABSTRACT
Presentamos el caso de un paciente de 39 años con multiples nodulos subcutaneos en rodillas, codos, cuellos de pie y pequeñas articulaciones de manos de seis años de evolucion asociado con la presencia de paniculitis por cristales de urato monosodico. La presencia de paniculitis en la gota es inusual, ha sido informada pocas veces en la literatura y creemos que debe considerarse a la gota dentro del diagnostico diferencial de ésta
Subject(s)
Gout/diagnosis , Panniculitis/diagnosis , Panniculitis/etiologyABSTRACT
Objetivo: actualizar el rol de las borrelias, en relación con varios cuadros nosológicos de interés dermatológico de etiología oscura, que han sido estudiados recientemente y deben ser más conocidos por los dermatólogos prácticos. Se analiza la enfermedad de Lyme y se discuten brevemente la esclerodermia localizada, liquen escleroso y atrófico, fasceítis eosinofílica, atrofodermia de Pasini y Pierini, granuloma anular, paniculitis septal, nódulos fibrosos subcutáneos, enfermedad de Jessner-Kanof, la hemiotrofia facial de Parry-Romberg y el linfoma B cutáneo primario que parecen asociarse con borrelias. La enfermedad de Lyme es un cuadro infeccioso sistémico, causado por espiroquetas del género Borrelia, transmitidas al hombre por garrapatas de género Ixodes. Tiene diversas manifestaciones cutáneas a lo largo de cada una de las etapas por las que atraviesa el proceso, por ejemplo el eritema migrans y el linfocitoma cutis (LC) en el estadío temprano y la acrodermatitis crónica atrofiante (ACA) en el estadío tardío. Se acompaña de síntomas principalmente neurológicos y reumatológicos. Existe tratamiento antibiótico útil, con dixiciclina, amoxicilina o eritromicina. Respecto a las otras enfermedades enumeradas, la terapia antibiótica anti-borrelia es todavía de valor discutible. Conclusión: si las diferentes entidades asociadas con borrelias son marcadores cutáneos de la enfermedad de Lyme o simplemente hallazgos coincidentes, es algo que aún está por determinarse
Subject(s)
Humans , Borrelia burgdorferi/drug effects , Borrelia Infections/complications , Borrelia Infections/diagnosis , Borrelia Infections/drug therapy , Borrelia/drug effects , Lyme Disease/complications , Lyme Disease/diagnosis , Lyme Disease/drug therapy , Acrodermatitis/etiology , Amoxicillin/therapeutic use , Doxycycline/therapeutic use , Erythema/etiology , Facial Hemiatrophy/etiology , Fasciitis/etiology , Granuloma Annulare/etiology , Lichen Sclerosus et Atrophicus/etiology , Panniculitis/etiology , Pseudolymphoma/etiologyABSTRACT
Las paniculitis son entidades que se caracterizan por una inflamación del tejido subcutáneo. Las provocadas por inoculación de diferentes sustancias las podemos agrupar en autoinducidas o iatrogénicas; dentro de ellas se reconocen la paniculitis facticia o autoprovocada y el lipogranuloma esclerosante. Presentamos un caso de paniculitis facticia, provocada por la inoculación de aceite para fricción, sustancia no descrita hasta el momento dentro de la lista de causas posibles
Subject(s)
Humans , Male , Middle Aged , Factitious Disorders/etiology , Iatrogenic Disease , Panniculitis/diagnosis , Factitious Disorders/diagnosis , Oils/adverse effects , Panniculitis/classification , Panniculitis/etiologyABSTRACT
Luego de una actualización de la histología y vascularización normales del Panículo adiposo y de una interpretación más ordenada de la patología general del tejido adiposo representamos una nueva clasificación clínico-patológica de las Paniculitis, basada en caracteres histopatológicos, clínicos y etiopatogénicos. I. PANICULITIS LIPOGRANULOMATOSAS: A. Sobre tejido adiposo normal: a) Paniculitis lipogranulomatosas sintomáticas (o secundarias): 1) PANICULITIS TRAUMATICA. 2) CITOESTEATONECROSIS MAMARIA. 3) PANICULITIS POR EL FRIO (Cold panniculitis. Adipose a frigore). 4) PANICULITIS SECUNDARIAS A INYECCIONES REABSORBIBLES: facticiais o medicamentosas. 5) PANICULITIS POR PICADURA DE ARTROPODOS. b) Paniculitis lipogranulomatosas idiopáticas (o primitivas): 1) PANICULITIS NODULAR FEBRIL RECIDIVANTE (WEBER-CHRISTIAN). 2) SARCOIDE DE DARIER-ROUSSY. 3) ERITEMA INDURADO DE BAZIN. 4) VASCULITIS NODULAR (MONT-GOMERY O'LEARY BARKER). 5) PERIARTERITIS NODOSA CUTIS (Hipodermitis micronodular crónica recidivante, Pierini y colob). 6) LIPOGRANULOMATOSIS DE MAKAI. 7) SINDROME DE ROTHMANN-MAKAI. B. Sobre tejido adiposo con cristales de ácidos grasos: 1) NECROSIS ADIPOSA SUBCUTANEA DEL RECIEN NACIDO. 2) PANICULITIS POST-ESTEROI8DES. C. Sobre tejido adiposo con "adipocitos fantasma (ghost-like cells): Dermatosis nodular en pancreatitis crónica agudizada y en cáncer de páncreas. II. PANICULITIS LIPOESCLEROSANTES: a) Formas espontáneas: PANICULITIS ESCLERODERMIFORME O CELULITIS INDURATIVA DE LOS MIEMBROS INFERIORES. b) Formas inducidas: por inyección de sustancias lipídicas o sintéticas no metabolizables: 1) PARAFINOMA (por inyección de parafina caliente licuada). 2) ELEIDOMAS (por inyección de aceites vegetales ricos en ésteres de glicerina). 3) TUMORES POR "ACEITE ALCANFORADO": Inyección de aceites minerales disueltos en aceite alcanforado (facticiais o medicamentosas). 4) SILICONOMAS (por inyección de siliconas líquidas)...