A patient with Pfeifer-Weber-Christian disease--successful therapy with cyclosporin A: case report.
BACKGROUND
Pfeifer-Weber-Christian disease (PWCD) is a rare inflammatory disorder of the subcutaneous fatty tissue. The diagnosis and therapy of this rare type of panniculitis is still controversial and will be discussed in this article.


METHODS
We here report the rare case of a 64-year old male patient, with PWCD. The patient suffered from rheumatoid arthritis for several years, but then developed relapsing fever and recently occurring painful subcutaneous nodules predominantly at the inner part of his left upper limb with no signs of synovitis. Finally, a biopsy from one of the nodules revealed lobular panniculitis with mixed cell infiltrate, which was conformable only with PWCD, after excluding several differential diagnoses. In our patient PWCD developed despite immunosuppressive therapy with steroids and different disease modifying drugs, which the patient received to treat his underlying rheumatoid arthritis. However, when DMARD therapy was switched to Ciclosporin A the patient's symptoms resolved.


CONCLUSIONS
Our observation supports the hypothesis that T cells are involved in the pathogenesis of PWCD. Thus, T cell modifying drugs should be primarily used to treat patients with this rare disorder.
Pongratz
Georg
G
Department of Internal Medicine I, University Medical Center Regensburg, Regensburg, Germany. georg.pongratz@klinik.uni-regensburg.de
Ehrenstein
Boris
B
Hartung
Wolfgang
W
Schölmerich
Jürgen
J
Fleck
Martin
M
D001132:Arm / Q000473:pathology; D001172:Arthritis, Rheumatoid / Q000150:complications; D001706:Biopsy; D016572:Cyclosporine / Q000627:therapeutic use*; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010201:Panniculitis, Nodular Nonsuppurative / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology; D013256:Steroids / Q000627:therapeutic use; D040521:Subcutaneous Tissue / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D013256:Steroids; D016572:Cyclosporine