Whipple's disease presenting with symmetrical panniculitis.
Specific cutaneous involvement in Whipple's disease is extremely rare. The condition usually runs a chronic course, with symptoms preceding diagnosis by years or even decades. We report a 44-year-old man who presented with a rapid onset of progressive, extensive, symmetrical plaques of panniculitis affecting the inner thighs and forearms. He had accompanying large joint arthritis and was profoundly anaemic. Biopsy of the subcutis revealed a florid septal panniculitis with infiltration of the septa by foamy macrophages containing intracellular granules that stained strongly with periodic acid-Schiff reagent. A similar but more intense infiltrate was seen in the small bowel lamina propria, and a diagnosis of Whipple's disease was made. Symmetrical panniculitis has not previously been reported as a manifestation of Whipple's disease.
Friedmann
A C
AC
Department of Dermatology, King's College Hospital, Denmark, Hill, London SE5 9RS, UK. adamfriedmann@fadmail.com
Perera
G K
GK
Jayaprakasam
A
A
Forgacs
I
I
Salisbury
J R
JR
Creamer
D
D
D000328:Adult; D018450:Disease Progression; D004386:Duodenum / Q000473:pathology; D006801:Humans; D008297:Male; D015434:Panniculitis / Q000209:etiology* / Q000473:pathology; D008061:Whipple Disease / Q000150:complications* / Q000473:pathology