An 82‐year‐old man presented with a 1‐year history of tender, erythematous, subcutaneous nodules mainly on both legs, but a few on the arms, up to 30–50 mm in diameter (Fig. ).Tender erythematous subcutaneous nodules on the leg.A deep incisional biopsy confirmed the clinical suspicion of panniculitis. Histology revealed a normal epidermis with a mild perivascular inflammatory infiltrate in the dermis, consisting of lymphocytes and eosinophils. In the underlying subcutaneous tissue, there was extensive enzymatic fat necrosis and a mixed inflammatory infiltrate with histiocytes. Multiple anucleate ghost cells were seen, composed of amorphous granular debris often with a rim of eosinophilia. This was in keeping with pancreatic panniculitis (Fig. ).Normal epidermis (asterisk) with a mild perivascular infiltrate in the dermis (arrowhead), while in the underlying subcutaneous tissue there was a lobular panniculitis with extensive enzymic fat necrosis (brackets) and ghost cells (arrow) (haematoxylin and eosin, original magnification × 10). Inset bottom right showing high power view of ghost cells (haematoxylin and eosin, original magnification × 40).The patient's full blood count, liver function tests, phosphate and adjusted calcium were within normal limits. His lipase level was significantly raised at 7674 IU/L (normal range with a raised erythrocyte sedimentation rate of 67
Clinical & Experimental Dermatology – Wiley
Published: Jan 1, 2018
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