Atypical lymphocytic lobular panniculitis: an overlap condition with features of subcutaneous panniculitis-like T-cell lymphoma and lupus profundus

Description

A woman aged 45 years presented for evaluation of skin lesions. She reported an 8–9-year history of occasionally tender, waxing-and-waning skin nodules refractory to dapsone, prednisone and methotrexate. Examination revealed multiple indurated subcutaneous nodules distributed on the upper extremities, with scattered patches of lipoatrophy in areas of nodule regression (figure 1). Her medical history was unremarkable; CBC and CMP were within normal limits, with no history of radiotherapy or evidence of internal organ involvement. She had a positive ANA titre (1:160, speckled), but negative anti-dsDNA, anti-Smith, anti-Ro and anti-La antibodies.

Figure 1

Multiple erythematous subcutaneous nodules distributed over the patient's right arm.

Differential diagnosis included erythema nodosum (EN), erythema induratum of Bazin (EIB), lupus profundus (LP) and cutaneous lymphoma.

Initial wedge biopsy in 2008 disclosed a predominantly lobular panniculitic process with some septal involvement (figure 2A). Broad zones of...

http://ift.tt/2fEKr0Y