Subacute Nodular Migratory Panniculitis (Vilanova Disease) Workup

  • Author: Sarah B Sawyer, MD; Chief Editor: William D James, MD   more...
 
Updated: Jan 19, 2012
 

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.
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Imaging Studies

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

  • A skin biopsy is necessary to make the diagnosis.[7]
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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.[8]

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.

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Contributor Information and Disclosures
Author

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.

Coauthor(s)

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

Disclosure: Nothing to disclose.

Vlada Groysman, MD  Staff Physician, Department of Dermatology, University of Alabama School of Medicine

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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 Dermatological Association

Disclosure: Nothing to disclose.

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, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

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

Christen M Mowad, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

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 and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

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. Feb 1959;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. Mar 1990;22(3):477-83. [Medline].

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

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

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

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

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

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

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

  11. 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. Oct 2000;43(4):691-7. [Medline].

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

  13. Niemi KM, Forstrom L, Hannuksela M, Mustakallio KK, Salo OP. Nodules on the legs. A clinical, histological and immunohistological study of 82 patients representing different types of nodular panniculitis. Acta Derm Venereol. 1977;57(2):145-54. [Medline].

 
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