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PReS-FINAL-2245: A rare case of subcutaneous panniculitis-like T cell lymphoma in a 9-month-old child
© Kozlova et al.; licensee BioMed Central Ltd. 2013
Published: 5 December 2013
Panniculitis is an inflammatory disorder of subcutaneous adipose tissue, frequently accompanied by vaculitis and systemic involvement. The peak age of patients is 20-30 years, and it is fairly rare in children, especially in infants.
Therefore, panniculitis-like lesions in young children require differential diagnostic procedures and sometimes joined efforts of rheumatologists, hematologists and oncologists.
to illustrate the difficulties in the diagnosis of subcutaneous panniculitis-like T cell lymphoma in an infant.
A 9-month-old child was admitted to our clinic in September 2012 for treatment of his panniculitis. First lesion on the face appeared in June 2012, abscess was suspected and it was surgically drained. Yet, in July 2012 there were new lesions and the boy started having daily spikes of fever. He was started on antibiotics without effect, the number and the size of lesions continued to grow. The biopsy was performed and based on the pathology results and symptoms the diagnosis of Weber panniculitis was made and the boy was referred to our center.
At the initial examination the boy appeared not well, very pale, had daily fevers, and multiple edematous purple skin lesions on his face, legs, arms. He had large peripheral lymph nodes (up to 3 cm), hepatosplenomegaly, anemia (hemoglobin to 88 g/L), mild leucopenia (WBC 3.2 × 109/ml), increased transaminases and lactate dehydrogenase. Chest X-ray, ultrasound of the abdomen, chest and abdomen CT were unremarkable, except for hepatosplenomegaly and obviously enlarged peripheral lymph nodes. Considering the age of the patient the diagnosis of panniculitis seemed questionable and the biopsy was repeated. As a result panniculitis-like T-cell lymphoma of the skin was diagnosed, the child was started on CHOP protocol treatment with dramatic improvement of his general condition and reduction of the lesions.
The case demonstrates the importance of critical approach to rheumatological patients that don't fit the general understanding of the pathology and epidemiology of the disorder.
Disclosure of interest
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.