A case of lipoatrophic panniculitis in a 2-year-old boy

Lipoatrophic panniculitis is generally a rare condition affecting mainly children, sometimes associated with connective tissue diseases [1, 2]. There are also reports about this condition occurring in adults [3]. This idiopathic, rarely reported panniculitis is presumed to have an autoimmune pathogenesis. A histopathological analysis reveals lobular panniculitis with fat necrosis and an associated inflammatory infiltration. Other histological findings are a focally increased number of lymphocytes rimming the adipocytes and infiltration of vascular walls by mildly atypical lymphoid cells [4]. Clinical and histopathological features lead to diverse diagnostic considerations like subcutaneous panniculitis-like T-cell lymphoma, Weber-Christian disease or Rothman-Makai syndrome [5].
We present a 2-year-old boy with no clinical or laboratory features of connective tissue disease who presented a progressive appearance of annular atrophic plaques with erythema on the right ankle. Skin lesions were about 2–3 cm in diameter with palpable loss of subcutaneous tissue (Figure 1). The patient was referred to the Chair and Clinical Department of Internal Diseases, Dermatology and Allergology in Zabrze after several consultations in other dermatology and rheumatology departments, with a suspicion of morphea, granuloma annulare or lipodystrophy. All blood tests like blood count, biochemical analysis, antinuclear antibodies and inflammatory markers were normal. Also X-ray of the lower limb was correct. There was no anamnesis of arthritis, thyroid gland abnormalities or fever. The first histopathological examination revealed acanthotic epidermis, collagen fiber protrusion, reduction of elastic fibers and in subcutaneous tissue – panniculitis. On the basis of the histological image, morphea profunda was suspected. However, the clinical picture with no immunological markers of connective tissue disease was still thought-provoking. The boy was treated with topical and systemic steroids for 6 months, and also with pentoxifylline and naproxen with no significant improvement. The second histopathological examination showed lymphocytes and histiocytes infiltration in the deep layers of dermis and subcutaneous tissue, in fatty tissue atrophy and inflammatory infiltration with histiocytes, lipofages similar to Touton cells and lymphocytes (Figure 2). On the basis of analyzed data, clinical and histopathological examination we identified lipoatrophic panniculitis. The...


View full text...