Subacute migratory panniculitis

Subacute migratory panniculitis of Vilanova, also known as migratory panniculitis of Vilanova, is a rare skin condition that was first described by Spanish dermatologist Dr. Josep Vilanova in 1960. It is characterized by the sudden appearance of painful, red, and tender nodules or subcutaneous nodules that appear mainly on the legs, but can also affect other parts of the body such as the arms, face, and torso. The nodules typically resolve on their own within a few days to weeks, but new nodules can appear in different areas of the body, giving the condition its characteristic migratory pattern.

Subacute migratory panniculitis of Vilanova (also known as nodular non-suppurative panniculitis or migratory panniculitis with subcutaneous nodules) is a rare autoimmune disease that affects the subcutaneous fat tissue, causing painful nodules and subcutaneous masses. The disease is characterized by its migratory nature, with new nodules appearing in different parts of the body as the old ones resolve.

The exact cause of subacute migratory panniculitis of Vilanova is unknown, but it is thought to be an autoimmune condition in which the body’s immune system attacks its own fat cells. Other possible causes include infections, medication reactions, and underlying systemic diseases.

There are several subtypes of subacute migratory panniculitis of Vilanova, including:

  1. Livedo reticularis-associated panniculitis: This subtype is characterized by the presence of a distinctive skin discoloration known as livedo reticularis, which appears as a mottled, net-like pattern on the skin. In this subtype, the painful nodules tend to be more widespread and persistent.
  2. Panniculitis nodularis with eosinophilia: This subtype is characterized by the presence of high levels of a type of white blood cell called eosinophils in the affected tissues. It is thought to be associated with underlying systemic diseases such as allergies or parasitic infections.
  3. Neutrophilic panniculitis: This subtype is characterized by the presence of high levels of a different type of white blood cell called neutrophils in the affected tissues. It is often associated with underlying infections, medications, or systemic diseases.
  4. Idiopathic panniculitis: This subtype is diagnosed when no underlying cause can be found.

Causes

Possible causes of subacute migratory panniculitis of Vilanova:

  1. Genetics: Some studies suggest that there may be a genetic component to the development of subacute migratory panniculitis of Vilanova, with a familial aggregation of cases reported in some families.
  2. Immune system dysfunction: An abnormal functioning of the immune system is thought to play a role in the development of subacute migratory panniculitis of Vilanova. The immune system attacks the subcutaneous fat layer, leading to inflammation and destruction of the fat cells.
  3. Infections: Some infections, such as hepatitis B and C, human immunodeficiency virus (HIV), and streptococcal infections, have been associated with the development of subacute migratory panniculitis of Vilanova.
  4. Medications: Certain medications, such as anti-tuberculosis drugs and nonsteroidal anti-inflammatory drugs (NSAIDs), have been linked to the development of subacute migratory panniculitis of Vilanova.
  5. Autoimmune diseases: Individuals with autoimmune diseases, such as systemic lupus erythematosus, rheumatoid arthritis, and scleroderma, have an increased risk of developing subacute migratory panniculitis of Vilanova.
  6. Inflammatory bowel disease: Inflammatory bowel diseases, such as Crohn’s disease and ulcerative colitis, have been linked to the development of subacute migratory panniculitis of Vilanova.
  7. Malignancies: Certain types of cancers, such as lymphomas and breast cancer, have been associated with subacute migratory panniculitis of Vilanova.
  8. Endocrine disorders: Endocrine disorders, such as diabetes mellitus, hyperthyroidism, and hypothyroidism, have been linked to the development of subacute migratory panniculitis of Vilanova.
  9. Trauma: Trauma to the affected area has been associated with the development of subacute migratory panniculitis of Vilanova.
  10. Vitamin deficiencies: Vitamin deficiencies, particularly deficiencies of vitamins B12 and E, have been linked to the development of subacute migratory panniculitis of Vilanova.
  11. Environmental factors: Exposure to certain environmental factors, such as pesticides, insecticides, and heavy metals, may increase the risk of developing subacute migratory panniculitis of Vilanova.
  12. Smoking: Smoking has been linked to the development of subacute migratory panniculitis of Vilanova.
  13. Alcohol consumption: Alcohol consumption has been associated with the development of subacute migratory panniculitis of Vilanova.
  14. Obesity: Obesity is a risk factor for the development of subacute migratory panniculitis of Vilanova.
  15. Physical inactivity: Physical inactivity and a sedentary lifestyle have been linked to the development of subacute migratory panniculitis of Vilanova.
  16. Stress: Stress has been associated with the development of subacute migratory panniculitis of Vilanova.

Symptoms

Common symptoms associated with subacute migratory panniculitis of Vilanova:

  1. Subcutaneous nodules: This is the most common and characteristic symptom of the disease, with painful, firm, and well-defined nodules appearing on the subcutaneous fat tissue.
  2. Migratory nature of the nodules: As old nodules resolve, new ones appear in different parts of the body.
  3. Pain and tenderness in the affected areas: The nodules can be quite painful, especially when pressed or touched.
  4. Swelling and redness: The affected areas may appear swollen and red due to inflammation.
  5. Heat and warmth in the affected areas: The affected areas may feel warm to the touch due to increased blood flow to the area.
  6. Fatigue and weakness: Many patients with subacute migratory panniculitis of Vilanova experience general fatigue and weakness, which can be severe in some cases.
  7. Weight loss: Some patients with the disease experience unexplained weight loss.
  8. Low-grade fever: Some patients may experience a low-grade fever, which can persist for several days or even weeks.
  9. Night sweats: Some patients experience excessive sweating at night.
  10. Joint pain and stiffness: Some patients with subacute migratory panniculitis of Vilanova experience joint pain and stiffness, which can be severe in some cases.
  11. Muscle pain: Some patients experience muscle pain and weakness, especially in the legs.
  12. Skin changes: Some patients with the disease experience changes in the skin, such as redness, itching, and dryness.
  13. Nausea and vomiting: Some patients experience nausea and vomiting, which can be severe in some cases.
  14. Loss of appetite: Some patients experience a loss of appetite and may experience significant weight loss as a result.
  15. Anemia: Some patients with subacute migratory panniculitis of Vilanova experience anemia, which can cause fatigue, weakness, and pale skin.
  16. Depression and anxiety: Some patients experience depression and anxiety due to the chronic nature of the disease.
  17. Sleep disturbances: Some patients experience sleep disturbances, including insomnia and vivid dreams.
  18. Visual changes: Some patients experience visual changes, such as blurred vision or double vision.
  19. Headaches: Some patients experience headaches, which can be severe in some cases.
  20. Raynaud’s phenomenon: Some patients with subacute migratory panniculitis of Vilanova experience Raynaud’s phenomenon, which is a condition where the fingers and toes turn white or blue in response to cold temperatures or stress.

Diagnosis

The following are some of the diagnostic tests that may be used in the evaluation of Subacute Migratory Panniculitis of Vilanova:

  1. Physical examination: A thorough physical examination is usually the first step in the diagnostic process. The healthcare provider will examine the affected areas, looking for signs of inflammation, swelling, and tenderness.
  2. Blood tests: Blood tests are commonly used to help diagnose Subacute Migratory Panniculitis of Vilanova. These tests may include a complete blood count (CBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) test, which can help detect inflammation in the body.
  3. Skin biopsy: A skin biopsy may be performed to obtain a small sample of the affected skin for laboratory analysis. The biopsy can help confirm the diagnosis of Subacute Migratory Panniculitis of Vilanova and rule out other conditions.
  4. Imaging tests: Imaging tests, such as X-rays, MRI, or ultrasound, may be used to evaluate the extent of the disease and to monitor its progression. These tests can help the healthcare provider determine the size and location of the nodules and subcutaneous lumps.
  5. Antinuclear antibody (ANA) test: The ANA test is used to detect the presence of antibodies in the blood that is directed against the patient’s own tissues. A positive ANA test result may indicate the presence of an autoimmune disease.
  6. HLA typing: HLA typing is a genetic test that can help determine if a person has a genetic predisposition to certain autoimmune diseases, including Subacute Migratory Panniculitis of Vilanova.
  7. Rheumatoid factor (RF) test: The RF test is used to detect the presence of antibodies in the blood that is directed against the patient’s own tissues. A positive RF test result may indicate the presence of rheumatoid arthritis or another autoimmune disease.
  8. Complement levels: Complement levels are blood tests that measure the levels of certain proteins in the blood that are involved in the body’s immune response. Low complement levels may indicate the presence of an autoimmune disease.
  9. Anti-dsDNA test: The anti-dsDNA test is used to detect antibodies in the blood that are directed against double-stranded DNA, a component of the patient’s own cells. A positive anti-dsDNA test result may indicate the presence of systemic lupus erythematosus (SLE).
  10. Anti-Ro/SSA and anti-La/SSB tests: These tests are used to detect antibodies in the blood that are directed against specific proteins involved in the immune response. A positive result may indicate the presence

Treatment

 

References