Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Subacute Nodular Migratory Panniculitis (Vilanova Disease) Workup

  • Author: Vlada Groysman, MD; Chief Editor: William D James, MD  more...
 
Updated: Dec 15, 2014
 

Laboratory Studies

The erythrocyte sedimentation rate is commonly elevated in patients with Vilanova disease.

The antistreptolysin O titer should be checked because it is elevated in some patients.

The physician should perform a tuberculin skin test because other diseases in the differential diagnosis can have tuberculous etiologies.

Serum rheumatoid factor levels have been elevated in some patients, although the reason for this is not known.

A CBC count can be performed to rule out infection, especially if the patient has described a sore throat or a fever.

An antinuclear antibody or anti-dsDNA antibody test can be ordered to help rule out lupus panniculitis.

An alpha1-antitrypsin level can be ordered to help rule out deficiency-induced panniculitis.

Anti-DNAse B titers also may be elevated, as they are often elevated in various forms of panniculitis.

Several cases have been reported of Vilanova disease associated with thyroid disease. Thyrotropin and free T4 levels should also be checked.

Next

Imaging Studies

A chest radiograph should be obtained to rule out sarcoidosis and tuberculosis.

Previous
Next

Procedures

A skin biopsy is necessary to make the diagnosis.[9]

Previous
Next

Histologic Findings

Subacute nodular migratory panniculitis is histologically characterized by granulation tissue–like capillary proliferation and septal widening secondary to granulomas and fibrosis. A mild lymphocytic and giant cell inflammation is observed, often lining the walls of the septa. Eosinophils and neutrophils may also be observed. The endothelial cells of the small vessels proliferate and can fill the entire lumen. The capillaries can take on a coiled, swollen appearance. Little to no vasculitis or phlebitis is present. The septa of the subcutaneous tissue exhibit granulomatous changes and notable changes in collagen fibers.[10]

In contrast, chronic erythema nodosum exhibits small vessel vasculitis and only mild septal change. Disease may extend to the adjacent fat lobules, and the inflammation often extends up to the deep dermis. Septal fibrosis is not present in chronic erythema nodosum.

Previous
 
 
Contributor Information and Disclosures
Author

Vlada Groysman, MD Medical Director, Cahaba Dermatology and Skin Health Center; Clinical Assistant Professor of Dermatology, University of Alabama at Birmingham School of Medicine

Vlada Groysman, MD is a member of the following medical societies: American Academy of Dermatology, Women's Dermatologic Society, Medical Dermatology Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Christen M Mowad, MD Professor, Department of Dermatology, Geisinger Medical Center

Christen M Mowad, MD is a member of the following medical societies: Alpha Omega Alpha, Noah Worcester Dermatological Society, Pennsylvania Academy of Dermatology, American Academy of Dermatology, Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Sungnack Lee, MD Vice President of Medical Affairs, Professor, Department of Dermatology, Ajou University School of Medicine, Korea

Sungnack Lee, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

Daniel Davis, MD Associate Professor, Departments of Dermatology, Otolaryngology, and Pathology, University of Arkansas for Medical Sciences

Disclosure: Nothing to disclose.

Sarah B Sawyer, MD Dermatology and Laser of Alabama

Sarah B Sawyer, MD is a member of the following medical societies: American Academy of Cosmetic Surgery, American Academy of Dermatology, American Society for Dermatologic Surgery, and American Society for Laser Medicine and Surgery

Disclosure: Nothing to disclose.

References
  1. Bafverstedt B. Not Available. Acta Derm Venereol. 1954. 34(3):181-93. [Medline].

  2. Vilanova X, Pinol Aguade J. Subacute Nodular Migratory Panniculitis. Br J Dermatol. 1959 Feb. 71(2):45-50. [Medline].

  3. de Almeida Prestes C, Winkelmann RK, Su WP. Septal granulomatous panniculitis: comparison of the pathology of erythema nodosum migrans (migratory panniculitis) and chronic erythema nodosum. J Am Acad Dermatol. 1990 Mar. 22(3):477-83. [Medline].

  4. Fine RM, Meltzer HD. Chronic erythema nodosum. Arch Dermatol. 1969 Jul. 100(1):33-8. [Medline].

  5. Vanegas ES, Cendejas RF, Mondragón A. A 41-year-old woman with migratory panniculitis. Am J Trop Med Hyg. 2014 May. 90(5):786-7. [Medline]. [Full Text].

  6. Sandoval M, Giesen L, Cataldo K, González S. Postirradiation Pseudosclerodermatous Panniculitis of the Leg: Report of a Case and Review of the Literature. Am J Dermatopathol. 2014 Jun 17. [Medline].

  7. Lee UH, Yang JH, Chun DK, Choi JC. Erythema nodosum migrans. J Eur Acad Dermatol Venereol. 2005 Jul. 19(4):519-20. [Medline].

  8. Requena L, Requena C. Erythema nodosum. Dermatol Online J. 2002 Jun. 8(1):4. [Medline]. [Full Text].

  9. Ross M, White GM, Barr RJ. Erythematous plaque on the leg. Vilanova's disease (subacute nodular migratory panniculitis). Arch Dermatol. 1992 Dec. 128(12):1644-5, 1647. [Medline].

  10. Rose C, Leverkus M, Fleischer M, Shimanovich I. Histopathology of panniculitis - aspects of biopsy techniques and difficulties in diagnosis. J Dtsch Dermatol Ges. 2011 Nov 16. [Medline].

  11. Perry HO, Winkelmann RK. Subacute nodular migratory panniculitis. Arch Dermatol. 1964 Feb. 89:170-9. [Medline].

  12. Schulz EJ, Whiting DA. Treatment of erythema nodosum and nodular vasculitis with potassium iodide. Br J Dermatol. 1976 Jan. 94(1):75-8. [Medline].

  13. Sterling JB, Heymann WR. Potassium iodide in dermatology: a 19th century drug for the 21st century-uses, pharmacology, adverse effects, and contraindications. J Am Acad Dermatol. 2000 Oct. 43(4):691-7. [Medline].

  14. Montgomery H, O'Leary P, Barker N. Nodular vascular diseases of the legs. JAMA. 1945. 128:335-41.

  15. Cho KH. Inflammatory nodules of the leg. Ann Dermatol. 2012 Nov. 24(4):383-92. [Medline]. [Full Text].

  16. Lazaridou E, Apalla Z, Patsatsi A, Trigoni A, Ioannides D. Erythema nodosum migrans in a male patient with hepatitis B infection. Clin Exp Dermatol. 2009 Jun. 34(4):497-9. [Medline].

Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.