Abstract

ROJAS-VILLARRAGA, Adriana et al. Panniculitis and erythema nodosum. A clinical and biological correlation. Rev.Colomb.Reumatol. [online]. 2006, vol.13, n.4, pp.253-257. ISSN 0121-8123.

Objective: to assess the frequency, etiologic factors, clinical patterns, histological types of panniculitis, and to correlate the different histologic patterns with stages of the disease. Material and methods: this is a prospective study of 60 patients with the diagnosis of panniculitis referred to our service between June 1994 and June 1998. A complete history and physical examination was performed, risk factors were evaluated. Laboratory studies were performed. A classification of the lesions depending on the predominant cellular type and tissue alterations were done, in early (incipient), established (active) and delayed injuries. Biopsy of the lesion and H&E examination was done in 26 patients. In addition, immunohistochemical analysis was performed using the following monoclonal antibodies (LCA, CD15, CD45Ro, CD45Ra, CD68, CD35, DR, DP, DQ, CD4 and CD8) to determine the presence or absence of leukocytes, and cellular subtypes including lymphocytes, T and B, polymorphonuclear, dendritic cells, and macrophages. A correlation between the clinical, histological and inmmunohistochemical findings, according to the stage of the lesions were established. Results: the majority of patients were women-55 (92%), mean age was 34 years. Nodular lesions were the most common - seen in 50/60 (83%), with lower extremities most commonly affected - 46/60 (77%). Most lesions were painful - 52/60 (87%). Both ESR and CRP were elevated in most patients. A precipitating event was present in 75%. Tonsillitis was present in 10/60 (17%). One-fourth (n=15) of patients did not exhibit clinical associated pathology. Of the 26 studies realized, histologically vasculitis was found in 2 cases, 6 cases were deemed to be in early stages of EN (23%), 12 (46%) were well developed active EN, and 6 (23%) exhibited late stage and in regression. Immunohistochemical analysis revealed: lymphocytes present in all cases. In early stages APC (DR, DP, DQ, CD35) and CD45Ro were the dominant types; in active lesions CD45Ro and to a lesser degree APC and macrophages (CD68) were the predominant cell types. In late stages CD45Ro lymphocytes were the dominant cell types. In the 2 cases with nodular vasculitis - CD15 PMN cells were the most frequent. Conclusion: erythema nodosum is a relatively frequent condition, most commonly seen in women, and of unknown etiology in 25% of cases. The diseases is presented in different clinical and histological stages. In early stages, APC and CD45Ro lymphocytes predominate, while in late stages CD45Ro T lymphocytes are the predominant cell type. In active and well developed stages, CD45Ro, APC and CD68 cells predominate. PMN (CD 15) appears to be the dominant cell type in the nodular vasculitic variant, with no predominance of neither APC o T lymphocytes, thus we inferred that they are totally different pathologies in its pathogenesis.

Keywords : panniculitis; erythema nodosum; immunohistochemical.

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