title: Redundant plantar skin folds.
abstract: A 46-year-old female patient presented with photosensitivity, symmetric arthritis, episodic plantar pain and strikingly redundant plantar skin folds, likely due to lipoatrophy after recurrent episodes of plantar panniculitis. In this context, leukopenia with lymphopenia, thrombocytopenia and positive antinuclear antibodies were revelatory for systemic lupus erythematosus. However, a small cerebriform plantar collagenoma, along with discrete dysmorphic features with downslanting palpebral fissures and mild right ptosis, second and third syndactyly and a larger first right toe since childhood, and early-onset bilateral ovarian cystadenoma, suggested a minimal Proteus syndrome. Genetic confirmation could not be performed. As adipose tissue dysregulation may be a feature of Proteus syndrome, the possible mechanisms leading to localized lipoatrophy in this setting are discussed. This case enlights intriguing links between adipogenesis, inflammation and dysmorphology. From a practical point of view, finding and treating an over-imposed inflammation could help limit damage in a hamartomatous syndrome.
authors.affiliation: Department of Rheumatology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania; siao_2003@yahoo.com.
authors.forename: Laura Otilia
authors.initials: LO
authors.lastname: Damian
authors.forename: Siao Pin
authors.initials: SP
authors.lastname: Simon
authors.forename: Ioana
authors.initials: I
authors.lastname: Felea
authors.forename: Carolina
authors.initials: C
authors.lastname: Botar-Jid
authors.forename: Bogdan
authors.initials: B
authors.lastname: Stancu
authors.forename: Liliana
authors.initials: L
authors.lastname: Rogojan
authors.forename: Cristina Ana Maria
authors.initials: CA
authors.lastname: Pamfil
authors.forename: Adriana
authors.initials: A
authors.lastname: Albu
authors.forename: Simona
authors.initials: S
authors.lastname: Rednic
mesh_terms: D005260:Female; D005528:Foot / Q000473:pathology*; D006801:Humans; D008875:Middle Aged; D016715:Proteus Syndrome / Q000209:etiology* / Q000473:pathology; D012871:Skin Diseases / Q000209:etiology* / Q000473:pathology