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The Journal of Dermatology Feb 2024Dermatomyositis constitutes a heterogeneous group of autoimmune inflammatory conditions with a wide variety of clinical outcomes. The symptomatic heterogeneity carries...
Dermatomyositis constitutes a heterogeneous group of autoimmune inflammatory conditions with a wide variety of clinical outcomes. The symptomatic heterogeneity carries skin, muscle, and joint manifestations; pulmonary and cardiac involvements; and concomitant malignancy. Any of these symptoms often appear at different combinations and time courses, thus posing difficulty in early diagnosis and appropriate treatment choice. Recent progress in laboratory investigations explored the identification of several myositis-specific autoantibodies (MSAs) and myositis-associated autoantibodies, allowing precise characterization for a clinical perspective of the disease. MSAs can be detectable in approximately 80% of patients with whole dermatomyositis, some of which closely reflect unique clinical features in the particular disease subset(s), including the distribution and severity of organ involvement, treatment response, and prognosis. However, only limited evidence has been available in dermatomyositis-associated panniculitis, mostly that in anti- melanoma differentiation-associated protein 5 antibody-positive disease. We present a rare case of a patients with dermatomyositis with extensive panniculitis on the trunk whose serum IgG autoantibodies reacted with both subunits of small ubiquitin-like modifier activating enzymes (SAEs), SAE1 and SAE2. The onset of panniculitis coincided with increased disease activity, including disease-related skin manifestations, fever, dysphagia, and muscle weakness in the extremities. These symptoms responded well to a high dose of systemic steroid, but even upon receiving a high-dose intravenous immunoglobulin, the panniculitic lesions and pruritic erythema flared with tapering of steroid dose, further requiring tacrolimus and mycophenolate mofetil to achieve disease remission. To our knowledge, this is the third reported case of anti-SAE autoantibody-positive dermatomyositis with panniculitis. We aim to extend the understanding of the current limitation and further perspective in the clinical management of the extremely rare skin manifestation associated with dermatomyositis.
Topics: Humans; Dermatomyositis; Myositis; Autoimmune Diseases; Autoantibodies; Panniculitis; Ubiquitin-Activating Enzymes; Steroids
PubMed: 37830399
DOI: 10.1111/1346-8138.17000 -
Skinmed 2023A 51-year-old man with a 3-year history of exogenous testosterone pellet injections to the left buttock presented for routine skin examination. While the patient...
A 51-year-old man with a 3-year history of exogenous testosterone pellet injections to the left buttock presented for routine skin examination. While the patient reported recurrent drainage from the site of testosterone replacement therapy (TRT) injections, he continued to receive repeated implantations every 6 months. On physical examination, a 12-mm irregular, brown macule was identified within a poorly demarcated, ecchymotic, and fluctuant subcutaneous plaque on the left buttock with a sinus tract draining serosanguinous fluid. The pigmented lesion was biopsied, revealing malignant melanoma ; hence, a wide local excision was scheduled. During the procedure, necrotic subcutaneous fat was observed surrounding the site of biopsy, and a region measuring 18 cm approximately was debrided and submitted for pathologic evaluation. Histopathologic examination revealed a diffused subcutaneous granulomatous infiltrate with septal and lobular panniculitis and fat necrosis as well as peripherally palisading histiocytes and hemosiderin deposition (Figures 1A and B). Similar findings were observed in another specimen from the same segment of debrided tissue, compatible with granulomatous panniculitis. Periodic acid-Schiff (PAS), Gram's, and acid-fast bacilli (AFB) stains revealed no microorganisms. During surgical exploration, six foreign bodies were discovered and identified as undissolved testosterone pellets. The patient was referred to a wound care center, but ultimately lost to follow-up.
Topics: Male; Humans; Middle Aged; Testosterone; Panniculitis; Subcutaneous Fat; Inflammation; Biopsy; Coloring Agents
PubMed: 37634108
DOI: No ID Found -
Medicina Clinica Jun 2024
Topics: Humans; Panniculitis, Peritoneal; Diagnosis, Differential; Neoplasm Recurrence, Local; Male; Middle Aged; Female
PubMed: 38378333
DOI: 10.1016/j.medcli.2023.11.045 -
Skin Health and Disease Oct 2023Sclerema neonatorum (SN) is a rare condition of neonatal panniculitis with a poor prognosis and a high fatality rate. It clinically presents as hardening of the skin and...
Sclerema neonatorum (SN) is a rare condition of neonatal panniculitis with a poor prognosis and a high fatality rate. It clinically presents as hardening of the skin and subcutaneous adipose tissue extending throughout the body, sparing the fat-free soles, palms, and genitalia. SN typically affects gravely ill, preterm neonates in the first week of life and diagnosis is often clinical. We report a case of an eight-day-old premature infant diagnosed with early-onset neonatal sepsis who presented with clinical and histopathological features of SN. Despite early treatment of the sepsis with intravenous antibiotics and the SN with a topical corticosteroid cream and moisturiser, the infant died on the twelfth day of life.
PubMed: 37799354
DOI: 10.1002/ski2.255 -
BMJ Case Reports Nov 2023Mesenteric panniculitis is a non-neoplastic condition involving inflammation and fibrosis of the small bowel mesentery. We describe a man in his 60s who presented with 3...
Mesenteric panniculitis is a non-neoplastic condition involving inflammation and fibrosis of the small bowel mesentery. We describe a man in his 60s who presented with 3 months of febrile episodes, confusion and weight loss. The diagnosis of mesenteric panniculitis had been established 2 weeks prior based on an abdominal computerized tomography scan. Extensive diagnostic investigations during his hospitalisation were unrevealing, and the symptoms were ultimately attributed to the mesenteric panniculitis. The fevers resolved over several weeks, and no further episodes have occurred since discharge. This case suggests that mesenteric panniculitis merits consideration in the differential diagnosis of fever of unknown origin.
Topics: Humans; Male; Abdomen; Diagnosis, Differential; Fever of Unknown Origin; Panniculitis, Peritoneal; Tomography, X-Ray Computed; Middle Aged
PubMed: 37914174
DOI: 10.1136/bcr-2023-254636 -
Annali Italiani Di Chirurgia Sep 2023Panniculitis is an inflammation of the subcutaneous fat common in patients defined as super-super obese (>60 kg/m2). Poor hygiene and skin infections are common in the...
OBJECTIVE
Panniculitis is an inflammation of the subcutaneous fat common in patients defined as super-super obese (>60 kg/m2). Poor hygiene and skin infections are common in the super morbidly obese group due to impaired metabolism of subcutaneous fat tissue, especially at abdominal folding. In our study, we will discuss the short-term results of panniculitis that develops as a result of these, simultaneously with bariatric surgery.
MATERIAL AND METHODS
In our study, six super morbid obese patients with Body Mass Index (BMI) of 80 kg/m2, 77 kg/m2, 74 kg/m2, 72 kg/m2, 68 kg/m2, 65 kg/m2, respectively, and sub umbilical skin tissue panniculitis were evaluated. These patients underwent bariatric surgery as a result of the obesity council decision. In the preoperative evaluation of the patients, it was observed that the blood supply to the subcutaneous fat tissues under the umbilicus was impaired, and the dermis/epidermis was hypertrophied.
RESULTS
Mean BMI of patients 73 kg/m2. Sleeve Gastrectomy (SG) was performed in 4 patients, Mini Gastric Bypass (MGB) was performed in 1 patient, and modified transit bipartition was performed in 1 patient. Infected erythematous lesions were detected on the skin secondary to ischemia, especially in some areas. After the patients performed the operations, a panniculectomy of approximately 70x30x20 cm was performed from under the umbilicus to the transverse line and up to the fascia.
CONCLUSION
Panniculectomy and bariatric surgery are recommended in the appropriate patient group. Extensive prospective studies are required to define further the burden of infectious morbidity and mortality conferred by obesity.
KEY WORDS
Bariatric surgery, Obesity, Panniculectomy.
Topics: Humans; Obesity, Morbid; Bariatric Surgery; Lipectomy; Abdominoplasty; Gastric Bypass
PubMed: 37737667
DOI: No ID Found -
Acta Dermato-venereologica Dec 2023
Topics: Humans; Macrophages; Panniculitis; Female; Aged; Drug Eruptions
PubMed: 38124380
DOI: 10.2340/actadv.v103.18855 -
European Journal of Dermatology : EJD Dec 2023
Topics: Humans; Panniculitis; Lymphoma, T-Cell; Skin Neoplasms; Diagnosis, Differential; Lymphoma, T-Cell, Cutaneous
PubMed: 38465570
DOI: 10.1684/ejd.2023.4626 -
Current Medical Imaging Aug 2023This case report presents a rare occurrence of lupus mastitis affecting the breast.
INTRODUCTION
This case report presents a rare occurrence of lupus mastitis affecting the breast.
CASE PRESENTATION
An induration with mild discomfort was detected in the upper inner quadrant of the right breast of a 27-year-old Chinese woman with regular menstrual cycles. The patient is currently unmarried and has no previous history of full-term pregnancies or lactation. An ill-defined, subcutaneous, hyperechoic lesion with no calcification was visualized on breast ultrasound. Peripheral and internal blood flow signals demonstrated high intensity. Pathological analysis of a breast needle biopsy revealed fat lobule necrosis accompanied by mixed lymphoplasmacytic and histiocytic aggregates.
CONCLUSION
The diagnosis of lupus mastitis necessitates a comprehensive evaluation of the patient's medical history, serological testing, imaging studies, and histopathological analysis.
PubMed: 37537937
DOI: 10.2174/1573405620666230804092737 -
Skin Health and Disease Apr 2024Myelodysplastic syndrome (MDS) may present with specific skin lesions, such as leukaemia cutis, which is a well known poor prognostic marker of leukaemia with a high...
Myelodysplastic syndrome (MDS) may present with specific skin lesions, such as leukaemia cutis, which is a well known poor prognostic marker of leukaemia with a high risk of acute leukaemic transformation. However, less is known regarding non-specific cutaneous manifestations of MDS including the prevalence, types and their prognostic and therapeutic significance, which we aimed to determine through this systematic review. We searched electronic databases (PubMed, Medline and EMBASE) from inception up to 26 January 2023 for studies reporting cutaneous manifestations of MDS. Eighty eight articles (case reports = 67, case series = 21), consisting of 134 patients were identified. We identified 6 common cutaneous manifestations: neutrophilic dermatoses ( = 64), vasculitis ( = 21), granulomatous ( = 8), connective tissue disease (CTD) ( = 7; composed of dermatomyositis ( = 5), cutaneous lupus erythematosus ( = 1), and systemic sclerosis ( = 1)), panniculitis ( = 4), immunobullous ( = 1), and other ( = 29). Cutaneous features either occurred at time of MDS diagnosis in 25.3%, preceding the diagnosis in 34.7% (range 0.5-216 months), or after diagnosis in 40.0% (range 1-132 months). Prognosis was poor (40.2% death) with 34.1% progressing to acute myeloid leukaemia (AML). 50% of those with MDS who progressed to AML had neutrophilic dermatoses ( = 0.21). Myelodysplastic syndrome was fatal in 39.2% of neutrophilic dermatoses (median time from onset of cutaneous manifestation: 12 months), 50% of vasculitis (7.5 months), 62.5% of granulomatous (15.5 months) and 14.3% of CTD (7 months). Recognition of patterns of cutaneous features in MDS will improve early diagnosis and risk stratification according to subtype and associated prognosis.
PubMed: 38577044
DOI: 10.1002/ski2.323