Successful treatment of severe cytophagic histiocytic panniculitis with cyclosporine A

Semin Arthritis Rheum. 1996 Jun;25(6):404-13. doi: 10.1016/s0049-0172(96)80005-9.

Abstract

Cytophagic histiocytic panniculitis (CHP) can be a severe variant of Weber-Christian disease characterized by the histopathologic appearance of lobular panniculitis infiltrated by histiocytes containing blood cell fragments and by a clinical course with marked systemic features including multiorgan failure, hypertriglyceridemia, and coagulopathy, which may lead to death. Therapy of CHP includes standard treatment for panniculitis, such as antimalarials, plus immunosuppressives for more severe cases. The response to treatment, however, is unpredictable. In several recent reports, cyclosporine A has been successfully used to treat panniculitis. We report a patient and review the literature on CHP and the use of cyclosporine A as therapy. Published reports reveal that in instances of severe CHP when cyclosporine A was not given, 19 of 27 patients died (70% mortality). When severe CHP was treated with cyclosporine A, rapid remission was achieved in our patient and all five previously published cases (0% mortality). We believe cyclosporine A is the drug of choice in severe CHP and should be considered in all such patients.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adolescent
  • Adrenal Cortex Hormones / therapeutic use
  • Biopsy
  • Bone Marrow / pathology
  • Cyclosporine / therapeutic use*
  • Female
  • Fever / complications
  • Humans
  • Indomethacin / therapeutic use
  • Leukocyte Count
  • Panniculitis, Nodular Nonsuppurative / diagnosis
  • Panniculitis, Nodular Nonsuppurative / drug therapy*
  • Panniculitis, Nodular Nonsuppurative / pathology
  • Skin / pathology

Substances

  • Adrenal Cortex Hormones
  • Cyclosporine
  • Indomethacin