title: Q fever: a new cause of 'doughnut' granulomatous lobular panniculitis.
abstract: Q fever is an uncommon zoonotic rickettsial disease with no exanthem or specific cutaneous lesions. Only nonspecific cutaneous involvement has been reported to date. A 69-year-old Spanish woman with chronic myelogenous leukaemia developed fever and two subcutaneous nodules. The patient complained of extreme pain. Biopsy revealed a granulomatous lobular panniculitis with a characteristic 'fibrin ring' or 'doughnut' appearance: fibrin and inflammatory cells arranged around a central clear space. Changes of membranous lipodystrophy were also found. Q fever serological studies were positive. Our patient had panniculitis with singular histopathological features. These histopathological changes have been described in liver and bone marrow of patients with Q fever. To the best of our knowledge, this cutaneous involvement due to Q fever has not previously been described in the literature.
authors.affiliation: Department of Dermatology, Hospital de Cabueñes, Gijón, Asturias, Spain. jocris@terra.com
authors.forename: C
authors.initials: C
authors.lastname: Galache
authors.forename: J
authors.initials: J
authors.lastname: Santos-Juanes
authors.forename: S
authors.initials: S
authors.lastname: Blanco
authors.forename: E
authors.initials: E
authors.lastname: Rodríguez
authors.forename: A
authors.initials: A
authors.lastname: Martínez
authors.forename: J
authors.initials: J
authors.lastname: Soto
mesh_terms: D000368:Aged; D005260:Female; D006099:Granuloma / Q000382:microbiology* / Q000473:pathology; D006801:Humans; D015434:Panniculitis / Q000382:microbiology* / Q000473:pathology; D011778:Q Fever / Q000150:complications / Q000175:diagnosis*; D012871:Skin Diseases / Q000382:microbiology* / Q000473:pathology