Subacute nodular migratory panniculitis, also known as
Weber-Christian disease, is a rare inflammatory condition that primarily affects the
subcutaneous fat. It is characterized by the presence of painful, red, and tender nodules that migrate and recur over time. The exact etiology is unknown, but it is thought to involve immune-mediated mechanisms.
Histological Features
On histological examination, subacute nodular migratory panniculitis shows characteristic patterns. The most notable features include:
- Lobular panniculitis: This refers to inflammation that primarily affects the lobules of subcutaneous fat.
- Mixed inflammatory infiltrate: The infiltrate often consists of neutrophils, lymphocytes, histiocytes, and occasional eosinophils.
- Fat necrosis: This is a hallmark of panniculitis, where adipocytes undergo necrosis and form fat-laden macrophages.
- Granulomatous inflammation: In some cases, granulomas containing multinucleated giant cells and epithelioid histiocytes are present.
- Fibrosis and septal thickening: Chronic inflammation can lead to fibrosis and thickening of the septa separating fat lobules.
Clinical Presentation
Patients with subacute nodular migratory panniculitis typically present with:
- Painful nodules: These are usually red, tender, and can vary in size.
- Migratory nature: The nodules often appear in one location and then resolve, only to recur in another area.
- Systemic symptoms: Some patients may experience fever, malaise, and weight loss.
Diagnosis
The diagnosis of subacute nodular migratory panniculitis is primarily clinical, supported by histological findings. A
skin biopsy is essential to confirm the diagnosis and rule out other causes of panniculitis such as infections, malignancy, and autoimmune diseases.
Differential Diagnosis
Other conditions that can present similarly and should be considered include:
- Erythema nodosum: Generally septal panniculitis with a different inflammatory pattern.
- Pancreatic panniculitis: Often associated with pancreatic disorders and shows characteristic "ghost cells."
- Lupus panniculitis: Associated with systemic lupus erythematosus and has distinctive histologic features such as hyaline fat necrosis and lymphocytic infiltrate.
Treatment
Treatment of subacute nodular migratory panniculitis focuses on managing symptoms and reducing inflammation. Options include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs): To alleviate pain and inflammation.
- Corticosteroids: For more severe cases, systemic corticosteroids may be necessary.
- Immunosuppressive agents: Such as methotrexate or azathioprine, in refractory cases.
Prognosis
The prognosis of subacute nodular migratory panniculitis varies. Some patients experience spontaneous remission, while others may have recurrent episodes over many years. Long-term management often focuses on symptom relief and monitoring for potential complications.
Conclusion
Subacute nodular migratory panniculitis is a rare and challenging condition to diagnose and manage. Histological examination is crucial for confirming the diagnosis and excluding other potential causes. Treatment is primarily symptomatic, with the aim of reducing inflammation and preventing recurrence.
