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Lupus Panniculitis — SCE Rheumatology MCQ

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HardSLE & Antiphospholipid SyndromeLupus PanniculitisSCE Rheumatology

A 35-year-old woman with systemic lupus erythematosus develops recurrent tender, deep subcutaneous nodules over the proximal upper arms and thighs. Several lesions have healed with depressed lipoatrophy. She has no fever, cytopenias or hepatosplenomegaly. A deep incisional biopsy including subcutaneous fat is performed. Which histological pattern most strongly supports lupus panniculitis (lupus profundus) rather than one of its principal mimics?

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Correct answer: E — Lobular lymphoplasmacytic panniculitis with hyaline fat necrosis and reactive lymphoid follicles

The characteristic pattern is a predominantly lobular lymphocytic or lymphoplasmacytic panniculitis with hyaline fat necrosis; reactive lymphoid aggregates or follicles may be present. Dermal mucin, interface change, perivascular or periappendageal inflammation and plasma cells can provide additional evidence of lupus. Option B suggests subcutaneous panniculitis-like T-cell lymphoma, an important mimic characterised by atypical cytotoxic T cells rimming adipocytes, although clinicopathological and molecular correlation may be required. Option A describes erythema nodosum. Neutrophilic panniculitis with ghost adipocytes suggests pancreatic panniculitis, while well-formed non-caseating granulomas favour sarcoidal panniculitis. Healing with lipoatrophy is clinically typical of lupus panniculitis.

Reference: Park HS, Choi JW, Kim B, Cho KH. Lupus erythematosus panniculitis: clinicopathological, immunophenotypic, and molecular studies. American Journal of Dermatopathology. 2010;32:24–30. https://pubmed.ncbi.nlm.nih.gov/35712102/