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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.


Imaging Studies

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



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


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.

Contributor Information and Disclosures

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.


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.

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