title: Locoregional multiple nodular panniculitis induced by Pseudomonas aeruginosa without septicemia: three cases and focus on predisposing factors.
abstract: OBJECTIVE
  Pseudomonas aeruginosa-induced locoregional multiple nodular panniculitis without septicemia is an underreported condition, with only 3 cases reported to date. We report 3 new cases of P aeruginosa-induced multiple nodular panniculitis without septicemia and describe common features among all 6 cases, thus providing the first description, to our knowledge, of the natural history and potential predisposing factors for this entity.
  
  
  METHODS
  Median age of the 6 patients was 74 years (range, 54-84 years). Patients had inflammatory nodules on a lower limb (n = 6) that were unilateral (n = 6) and had no fever (n = 5). Blood cultures were negative (n = 5). Skin biopsy specimens revealed panniculitis (n = 5), with skin cultures positive for P aeruginosa (n = 6). Skin nodules resolved with systemic antibiotics (n = 5). The comorbidities recorded were type 1 or 2 diabetes mellitus (n = 5), overweight (n = 3), and combined locoregional anatomical changes in the lower limbs (n = 5). Local skin injury, which constituted the portal entry, was present in all cases, especially leg ulcers (n = 3).
  
  
  CONCLUSIONS
  We describe P aeruginosa-induced locoregional nodular panniculitis as a distinct entity. This should be investigated in elderly, diabetic, overweight patients with inflammatory nodules on a lower limb associated with locoregional anatomical changes and skin injury, with the optimal antibiotic regimen introduced as rapidly as possible.
authors.affiliation: Department of Dermatology, University François Rabelais, Hospital of Tours, Tours, France.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Roriz
authors.affiliation: Department of Dermatology, University François Rabelais, Hospital of Tours, Tours, France2INSERM U930, University François Rabelais, Tours, France.
authors.forename: Annabel
authors.initials: A
authors.lastname: Maruani
authors.affiliation: Department of Dermatology, University François Rabelais, Hospital of Tours, Tours, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Le Bidre
authors.affiliation: Department of Pathology, University François Rabelais, Hospital of Tours, Tours, France.
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Machet
authors.affiliation: Department of Dermatology, University François Rabelais, Hospital of Tours, Tours, France2INSERM U930, University François Rabelais, Tours, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Machet
authors.affiliation: Department of Dermatology, University François Rabelais, Hospital of Tours, Tours, France4Laboratory of Molecular Virology and Immunology, ISP 1282, INRA-University François Rabelais, Tours, France.
authors.forename: Mahtab
authors.initials: M
authors.lastname: Samimi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015984:Causality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015434:Panniculitis / Q000453:epidemiology / Q000382:microbiology* / Q000473:pathology*; D011552:Pseudomonas Infections / Q000453:epidemiology; D011550:Pseudomonas aeruginosa; D018805:Sepsis