Panniculitis Flashcards
Causes of septal panniculitis withOUT vasculitis
Panniculitis, Septal without vasculitis - GRENS
Granuloma annulare (deep)
Rheumatoid nodules
Erythema nodosum (look for granulomatous inflammation Mieschner’s granulomas)
NLD, Necrobiotic xanthogranuloma
Scleroderma/Morphoea
Causes of septal panniculitis with vasculitis
Panniculitis, Septal with vasculitis - LSP
LCV (severe)
Superficial thrombophlebitis
PAN
Lobular panniculitis WITH vasculitis
Panniculitis, Lobular with vasculitis - EE
Erythema induratum Bazin / Whitfield
Erythema nodosum leprosum
Lobular panniculitis withOUT vasculitis
Panniculitis, Lobular without vasculitis - PANNICULITIS
Pancreatic
Alpha 1 antitrypsin
Newborn, subcutaneous fat necrosis of the
Neonatorum, sclerema
Infiltrates eg lymphoma, Infectious panniculitis (typical/atypical myco, deep fungal)
CTD (lupus, DM, eosinophilic fasciitis),** Cold, Cytophagic histiocytic panniculitis, Crystal (Ca, gout, cholesterol)
Unknown: Weber-Christian
Lipodermatosclerosis, lipoatrophy, lipodystrophy / Lymphoma
IBR and other eosinophilic (Well’s, parasite, hypereosinophilic)
Traumatic
Injected or induced artificially (factitial)
Sweet’s, post Steroid, S**arcoid
Histo features of EN
**Septal **panniculitis
WITHOUT vasculitis
Lymphocytes, histiocytes, neutrophils, and/or eosinophils.
Multinucleated giant cells in older lesions, without caseation
Mild fat necrosis sometimes, with foamy histiocytes
Label
What type of panniculitis is this?
Septal panniculitis
DDx of septal panniculitis
Erythema Nodosum
Erythema induratum
Infection-related panniculitis
What is the histology of cold panniculitis?
Lobular panniculitis of neutrophils, lymphocytes, and
histiocytes
Cystic spaces in subcutaneous fat due to ruptured fat cells
Label
Label
What are the histo features of erythema induratum?
Lobular granulomatous panniculitis
Mixed infiltrate of lymphocytes, histiocytes, plasma cells, and multinucleated giant cells
Ulceration sometimes
Caseation necrosis sometimes
Vasculitis in the fat often involving arteries or small veins
Fibrosis in older lesions
DDx of Erythema iduratum
EN
Other granulomatous disease
PAN
Infection related panniculitis
Label
Label
What are the histological features of pancreatic panniculitis?
Mixed lobular panniculitis with lymphocytes, foamy histiocytes, and multinucleated giant cells
Fat necrosis with “ghost-like” fat cells and basophilic deposits of calcium salts of fatty acids
Panniculitis with needle-shaped clefts with lipocytes
Their presence favors a diagnosis of sclerema neonatorum, subcutaneous fat necrosis of the newborn, or post-steroid panniculitis
Describe
Septal panniculitis
Miesher microgranuloma
Multinucleated giant cell
What are the features of sclerema neonatorum?
Severly ill premature neonates
In the first week of life
Widespread, diffuse hardening, sparing only the genitalia, palms and soles; cool, waxy, rigid and board-like skin with purple mottled discoloration
Respiratory difficulties, congestive heart failure, intestinal obstruction, diarrhea; death, usually from septicemia, in three- quarters of patients
What are the features of subcutaneous fat necrosis of the newborn?
Occurs in the first 2 -3 weeks of life
Circumscribed, erythematous, indurated subcutaneous nodules, favoring the cheeks, shoulders, back, buttocks, thighs; may become fluctuant
Spontaneous resolution is common
Ass with:
Hypercalcemia (onset usually within 2 months),
thrombocytopenia,
hypertriglyceridemia;
severe hypercalcemia may be associated with fever, eosinophilia, and persistent nephrocalcinosis
What are the clinical features of post-steroid panniculitis?
Occurs in children aged 1 - 14 years
1 - 40 days after cessation of high-dose systemic corticosteroids
Firm red plaques on the cheeks, arms, trunk; small and discrete or large and confluent lesions; pruritic, tender or asymptomatic
Describe and DDx
Erythemarous to purple to violaceous indurated nodules and plaques
DDx:
- subcutaneous fat necrosis of the newborn
- sclerema neonatorum
- post-steroid induced panniculitis
- NAI
Panniculitis, Ulcerating, Causes
NICE PLANT
Neutrophilic (assoc with RA, subcutaneous Sweet’s)
Infective (EI)
Calciphylaxis, Cytophagic histiocytic panniculitis
Enzymatic (pancreatic, alpha 1 antitrypsin)
PAN
Lymphoma
Alpha 1 antitrypsin
NLD
Trauma, factitial
