Locoregional multiple nodular panniculitis induced by Pseudomonas aeruginosa without septicemia: three cases and focus on predisposing factors. 2014

Mélanie Roriz, and Annabel Maruani, and Emmanuelle Le Bidre, and Marie-Christine Machet, and Laurent Machet, and Mahtab Samimi
Department of Dermatology, University François Rabelais, Hospital of Tours, Tours, France.

OBJECTIVE Pseudomonas aeruginosa-induced locoregional multiple nodular panniculitis without septicemia is an underreported condition, with only 3 cases reported to date. We report 3 new cases of P aeruginosa-induced multiple nodular panniculitis without septicemia and describe common features among all 6 cases, thus providing the first description, to our knowledge, of the natural history and potential predisposing factors for this entity. METHODS Median age of the 6 patients was 74 years (range, 54-84 years). Patients had inflammatory nodules on a lower limb (n = 6) that were unilateral (n = 6) and had no fever (n = 5). Blood cultures were negative (n = 5). Skin biopsy specimens revealed panniculitis (n = 5), with skin cultures positive for P aeruginosa (n = 6). Skin nodules resolved with systemic antibiotics (n = 5). The comorbidities recorded were type 1 or 2 diabetes mellitus (n = 5), overweight (n = 3), and combined locoregional anatomical changes in the lower limbs (n = 5). Local skin injury, which constituted the portal entry, was present in all cases, especially leg ulcers (n = 3). CONCLUSIONS We describe P aeruginosa-induced locoregional nodular panniculitis as a distinct entity. This should be investigated in elderly, diabetic, overweight patients with inflammatory nodules on a lower limb associated with locoregional anatomical changes and skin injury, with the optimal antibiotic regimen introduced as rapidly as possible.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D011550 Pseudomonas aeruginosa A species of gram-negative, aerobic, rod-shaped bacteria commonly isolated from clinical specimens (wound, burn, and urinary tract infections). It is also found widely distributed in soil and water. P. aeruginosa is a major agent of nosocomial infection. Bacillus aeruginosus,Bacillus pyocyaneus,Bacterium aeruginosum,Bacterium pyocyaneum,Micrococcus pyocyaneus,Pseudomonas polycolor,Pseudomonas pyocyanea
D011552 Pseudomonas Infections Infections with bacteria of the genus PSEUDOMONAS. Infections, Pseudomonas,Pseudomonas aeruginosa Infection,Infection, Pseudomonas,Pseudomonas Infection,Pseudomonas aeruginosa Infections
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D000369 Aged, 80 and over Persons 80 years of age and older. Oldest Old
D015434 Panniculitis General term for inflammation of adipose tissue, usually of the skin, characterized by reddened subcutaneous nodules. Panniculitis, Subacute Nodular Migratory,Cold Panniculitis,Cold Panniculitides,Panniculitides,Panniculitides, Cold,Panniculitis, Cold
D015984 Causality The relating of causes to the effects they produce. Causes are termed necessary when they must always precede an effect and sufficient when they initiate or produce an effect. Any of several factors may be associated with the potential disease causation or outcome, including predisposing factors, enabling factors, precipitating factors, reinforcing factors, and risk factors. Causation,Enabling Factors,Multifactorial Causality,Multiple Causation,Predisposing Factors,Reinforcing Factors,Causalities,Causalities, Multifactorial,Causality, Multifactorial,Causation, Multiple,Causations,Causations, Multiple,Enabling Factor,Factor, Enabling,Factor, Predisposing,Factor, Reinforcing,Factors, Enabling,Factors, Predisposing,Factors, Reinforcing,Multifactorial Causalities,Multiple Causations,Predisposing Factor,Reinforcing Factor

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