PANNICULITIS (panniculitis; lat. pannus a rag, a piece of fabric + - itis; synonym: cellulitis, necrosis of fatty tissue) — the aseptic nonspecific inflammation of hypodermic cellulose of various genesis caused by disturbance of peroxide oxidation of lipids.
Depending on etiol, a factor distinguish P. artificial (artificial), arising on site injections of oil drugs or insulin and followed by development of a lipodystrophy, and symptomatic — result of injuries, intoxications, infectious diseases, napr, a sapropyra, caused substantially by local disturbances of blood circulation in a combination with action of toxic factors (see. Lipogranuloma ).
A specific place is held by spontaneously developing disease — the recurrent feverish not suppurating panniculitis (synonym: Weber-Krischena a disease, Pfeyfera — Weber — Krischena a syndrome, a generalized lipogranulomatosis), described by V. Pfeifer in 1892 under the name «focal atrophy of a hypodermic fatty tissue». Weber (F. The ruble of Weber) in 1925 allocated it as an independent disease — recurrent not purulent knotty P.; Krischen (N. of A. Christian) in 1928 characterized the course of this process. Its weakened option — — Dip a spontaneous panniculitis of Rotmann, or — Dip Rotmann's syndrome, differs in systemic lesion of hypodermic cellulose, it is described by Rotmann (M. Rothmann) in 1894 and in more detail E. Makai in 1928.
Etiology and pathogeny the recurrent feverish not suppurating P. are not established; assume infectious and allergic genesis of a disease, the role of a lipotropic virus is not excluded. Endocrinopathies, dysfunctions of a pancreas, constitutional feature of hypodermic cellulose, and also an injury, overcooling can be the contributing factors.
At the beginning of a disease inflammatory infiltration of hypodermic cellulose is expressed. Infiltrate consists of leukocytes, lymphocytes, histiocytes. Further histiocytes, densely infiltriruyushchy hypodermic cellulose, increase in sizes, get into lipoblasts and absorb them, forming «foamy» cells — their protoplasm has a foamy appearance, the number of kernels is increased. In a final stage inflammatory process is replaced by fibrosis, an atrophy (sometimes with petrification) hypodermic cellulose.
The disease develops at corpulent women aged from 20 up to 40 years more often. On extremities (hips, shins, shoulders), is more rare on a trunk, in hypodermic cellulose arise painful, various in size (to dia. 1 — 10 cm and more) and density randomly located nodes. Gradually nodes are accustomed to drinking with skin, edges are got by purple-red color. In process of development of an atrophy of fatty tissue in a zone of a node retraction of skin, a hyperpegmentation is formed. Very seldom nodes are opened with allocation of an oily liquid. The recurrent current is characteristic hron; a recurrence is followed by formation of new nodes, disturbance of the general condition of the patient, fever, a leukopenia. Defeats of a big epiploon, cellulose of retroperitoneal space, and also a liver, lungs are possible.
— Dip a spontaneous panniculitis of Rotmann clinically proceeds more favorably; absence of fever and other general manifestations, bystry involution of nodes without cicatricial atrophy of fatty tissue is characteristic of it.
Diagnosis establish on the basis a wedge, the picture confirmed in doubtful cases gistol. research of skin. The differential diagnosis is carried out with hypodermic sarcoids (see. Sarcoidosis ), blyashechny scleroderma (see), a knotty vasculitis (see. Vasculitis of skin ), lipomatozy (see), a syphiloma (see. Syphilis ), leprosy (see), a nodular periarteritis (see. Periarteritis nodular ).
Treatment carry out by antibiotics, corticosteroid drugs, drugs of a hingaminovy row (Resochinum, delagil, Chingaminum), salicylates.
Prevention aggravations consists in the prevention of overcoolings and injuries.
Forecast for life favorable is more often; in case of damage of internals the lethal outcome is possible.
Bibliography: White G. B. and In er-benko E. V. K to the kliniko-morphological characteristic of a disease of Weber — Krischena, Vestn, dermas, and veins., No. 2, page 14, 1971; Gurevich M. A. ides of river. Visceral defeats at Weber's disease — Krischena, Rubbed. arkh., t. 45, No. 1, page 91, 1973; Egorov V. P. A recurrent knotty panniculitis of Weber — Christiaan, the Doctor, business, No. 8, page 92, 1980; M I with N and - to about in M. N. Pannikulit, Surgery, No. 8, page 99, 1979; Raznatovskiy. M and Rodionov A. N. About communication of a panniculitis of Weber — Krischena with a pancreatic cancer, Vestn, dermas, and veins., No. 6, page 58, 1978; Slepyninv. And. and Sh e of l and N and Je. A. Bolezn Webera — Christiaan, Arkh. patol., t. 35, No. 6, page 64, 1973; Craciun E. Page Diagnostic di-ferential pentru paniculite septice §i asep-tice, Probl. Ter. (Buc.), v. 10, p. 42, 1959; GriinebergTh.u. Heidelmann G. Rezidivierende Knotige Pannikulitis (Weber — Christian) mit Gelenk-und Ge-fassbeteiligung, Dtsch. Gesundh. - Wes., Bd 13, S. 543, 1958, Bibliogr.
O. K. Shaposhnikov.