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E-IJD® - CORRESPONDENCE
Year : 2022  |  Volume : 67  |  Issue : 4  |  Page : 480
Erythematous, non-tender plaques on the shins: A case of idiopathic eosinophilic panniculitis


From the Departments of Dermatology and Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India

Date of Web Publication2-Nov-2022

Correspondence Address:
Jaspriya Sandhu
From the Departments of Dermatology and Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.ijd_1040_20

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How to cite this article:
Sandhu J, Gupta SK, Garg B. Erythematous, non-tender plaques on the shins: A case of idiopathic eosinophilic panniculitis. Indian J Dermatol 2022;67:480

How to cite this URL:
Sandhu J, Gupta SK, Garg B. Erythematous, non-tender plaques on the shins: A case of idiopathic eosinophilic panniculitis. Indian J Dermatol [serial online] 2022 [cited 2022 Dec 4];67:480. Available from: https://www.e-ijd.org/text.asp?2022/67/4/480/360292




Sir,

Eosinophilic panniculitis (EP) is characterized by a prominent infiltration of subcutaneous fat with eosinophils. It is known to be associated with a diverse group of disorders; erythema nodosum, insect bite, gnathostomiasis, atopic dermatitis, various neoplasia and haematological disorders are often found to be the etiology.[1] It is essentially a nonspecific reactive process where the presence of eosinophils is seen in the subcutaneous fat.[2] In this article, we describe an unusual case of idiopathic EP in a young man.

A 20-year-old man presented to us with gradual onset of reddish, painless-raised lesions on bilateral shins with mild pedal oedema. He also had low-grade fever; however, there was no associated pain, itching/burning over the lesions. At the time of presentation, patient had bilaterally symmetrical erythematous to violaceous, raised, indurated, annular plaques of size approximately 16 × 10 cm2 over right leg and 12 × 10 cm2 over left leg as well as bilateral pitting pedal oedema [Figure 1]. Systemic examination was within normal limits. Laboratory examination revealed leukocytosis and markedly increased eosinophilic counts (46%); peripheral smear showed leukocytosis with eosinophilia, no atypical cells were seen.
Figure 1: Multiple, erythematous, oval to annular, nontender and indurated plaques over bilateral shins

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On his first visit, the patient was given a course of systemic antibiotic, as the counts were significantly raised. The lesions and leukocyte count improved slightly, but the lesions recurred. A detailed evaluation was then undertaken on his subsequent visit. We could not elicit any relevant history of nay potential triggers (arthropod bite/trauma/upper respiratory tract infection/joint pains/gastrointestinal tract infection/Raynaud's disease/contact dermatitis/atopic dermatitis).

Routine investigations (liver and renal function tests, antistreptolysin O titers, erythrocyte sedimentation rate, antinuclear antibody, urine routine examination, chest X-ray, Mantoux) did not show any abnormality. A skin biopsy was done, after informed consent, from the advancing margin of the lesion on the left leg. The histopathological examination showed acanthosis, papillary oedema and inflammatory infiltrate in the dermis [Figure 2]a. Dense inflammatory infiltrate in the subcutaneous tissue showed lobular panniculitis [Figure 2]b. The infiltrate comprised predominantly eosinophils with plasma cells [Figure 2]c.
Figure 2: (a, 100×, haematoxylin and eosin [H &E]) Acanthosis of the epidermis, papillary oedema is seen. Inflammatory infiltrate seen in the dermis. (b, 100×, H &E) Dense inflammatory infiltrate, with eosinophil predominance, seen in the subcutaneous tissue; Lobular panniculitis. (c, 400×, H &E) Predominantly eosinophilic inflammatory infiltrate with plasma cells visualized on higher magnification

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On the basis of clinical, laboratory and histopathological findings, we made a diagnosis of EP. He was started on oral corticosteroids with marked clinical improvement as well as reduction in eosinophilia. The corticosteroids were gradually tapered over 6 weeks; patient is currently in remission and remains in follow-up.

EP was first described by Burket and Burket in 1985, may be triggered by a number of conditions leading to a cytokine-induced aberrant immune response[3–6] EP is a histopathological term rather than a distinct entity. There are 2 age peaks: the third decade and the sixth decade; with females more frequently affected (M:F = 3:1).[7] The skin lesions can vary from urticarial plaques, papules, pustules to purpura and ulcerative lesions, but they always include a nodular, subcutaneous component.[8] A pertinent history followed by thorough examination. Investigation should include both routine laboratory tests along with serological studies, erythrocyte sedimentation rate, chest X ray, antistreptolysin O titers, antinuclear antibody, immunoglobulin E levels and cultures depending on the preliminary findings.[8]

The histopathological examination shows dermal inflammatory infiltrate predominantly composed of eosinophils along with few lymphocytes and histiocytes, within thickened septa and lobules. It is a self-limiting condition and shows good response to oral corticosteroids as well as dapsone.[3] Recently, EP in association with COVID-19 (coronavirus disease-2019) presenting as erythematous/brownish subcutaneous nodular lesions has been recently described.[9]

In our case, we were unable to find any underlying cause; idiopathic EP is a rare entity that responds well to corticosteroids.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Ustuner P, Dilek N, Saral Y, Dilek AR, Bedir R. Eosinophilic panniculitis presenting with Kaposi's sarcoma-like plaques in a patient who is human immunodeficiency virus positive: A case report. J Med Case Rep 2012;6:387.  Back to cited text no. 1
    
2.
Requena L, Yus ES. Panniculitis. Part II. Mostly lobular panniculitis. J Am Acad Dermatol 2001;45:325-61.  Back to cited text no. 2
    
3.
Jain S, Jain P, Jakhar P, Shivkumar VB. Eosinophilic panniculitis in a female child: An unusual presentation. Indian Dermatol Online J 2015;6:34-6.  Back to cited text no. 3
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4.
Perez C, Vives R, Montes M, Ostiz S. Recurrent eosinophilic panniculitis associated with Fasciola hepatica infection. J Am Acad Dermatol 2000;42:900-2.  Back to cited text no. 4
    
5.
Rodríguez-Lojo R, Almagro M, Piñeyro F, Pérez-Varela L, Fernández-Jorge B, Del Pozo J, et al. Eosinophilic panniculitis and insect bite-like eruption in a patient with chronic lymphocytic leukaemia: A spectrum of the same entity. Dermatol Res Pract 2010;2010:263827. doi: 1155/2010/263827.  Back to cited text no. 5
    
6.
Oliveira-Neto MP, Mattos M, Cuzzi-Maya T, Pirmez C. Localized eosinophilic panniculitis following intramuscular injection of pentavalent antimonium for treatment of American tegumentary leishmaniasis. An Bras Dermatol 2004;79:463-9. https://doi.org/10.1590/S0365-05962004000400008.  Back to cited text no. 6
    
7.
Luzar B, Calonje E. Inflammatory diseases of the subcutaneous fat. In: Calonje E, Brenn T, Lazar A, Mckee PH, editors. Mckee's Pathology of the Skin. 4th ed. Amsterdam: Elsevier Publishing; 2012. p. 326-61.  Back to cited text no. 7
    
8.
Adame J, Cohen PR. Eosinophilic panniculitis: Diagnostic considerations and evaluation. J Am Acad Dermatol 1996;34:229-34.  Back to cited text no. 8
    
9.
Leis-Dosil VM, Sáez Vicente A, Lorido-Cortés MM. Eosinophilic panniculitis associated with COVID-19. Actas Dermosifiliogr (Engl Ed) 2020;111:804-5. doi: 10.1016/j.adengl. 2020.10.003.  Back to cited text no. 9
    


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