Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Art & Psychiatry
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Conference Oration
Conference Summary
Continuing Medical Education
Cosmetic Dermatology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
Editor Speaks
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Miscellaneous Letter
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News & Views
Observation Letter
Observation Letters
Original Article
Original Contributions
Pattern of Skin Diseases
Pediatric Dermatology
Pediatric Rounds
Presedential Address
Presidential Address
Presidents Remarks
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Review Article
Review Articles
Revision Corner
Self Assessment Programme
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Study Letter
Study Letters
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapy Letter
Therapy Letters
View Point
What’s new in Dermatology
View/Download PDF

Translate this page into:

Letter to the Editor
doi: 10.4103/0378-6323.98084

Panniculitis associated with Sjögren's syndrome

Yu-Chen Huang1 , Ming-Hsiu Lin2
1 Department of Dermatology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
2 Department of Dermatology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan

Correspondence Address:
Ming-Hsiu Lin
Department of Dermatology, Shuang Ho Hospital, Taipei Medical University, No.291, Jhongjheng Rd, Jhonghe District, New Taipei City
How to cite this article:
Huang YC, Lin MH. Panniculitis associated with Sjögren's syndrome. Indian J Dermatol Venereol Leprol 2012;78:491-493
Copyright: (C)2012 Indian Journal of Dermatology, Venereology, and Leprology


Various cutaneous manifestations are occasionally associated with Sjögren′s syndrome (SS) including purpura and urticaria, usually with either a leukocytoclastic, or with lymphocytic vasculitis. [1] Panniculitis associated with SS is a rare cutaneous manifestation. Here, we report a case of a SS patient with septal panniculitis.

A 32-year-old male patient presented himself with a 3-month history of tender, indurated nodules and plaques on bilateral legs. He denied other family history and drug history. Review of systems showed the findings of arthralgia, dry eyes and dry mouth. He did not have cough, sore throat and fever. The result of the physical examination showed several erythematous nodules and plaques over anterior and lateral aspect of bilateral legs, and fine scales over some plaques [Figure - 1].

Figure 1: Several tender erythematous plaques over the lateral aspect of lower leg. The arrow pointed the lesion of incisional biopsy

The findings of laboratory tests showed a positive anti-nuclear antibody (Ab) (1: 2560 with a speckled pattern), anti-Ro antibody (> 240.00 IU/mL), anti-La antibody (45.10 IU/mL), rheumatoid factor (165.0 IU/ mL), elevated erythrocyte sedimentation rate (94 mm/h), and decreased hemoglobin (12.3 g/ dL). Test results for liver and renal function, urine analysis, anti-double strand DNA Ab, anti-Sm Ab, anti-RNP Ab, anti-cardiolipin Ab and complement were all within normal limits. The result of chest X-ray film was normal. A Schirmer′s test was performed and showed the finding of 1 mm on bilateral eyes. Sialoscintigraphy showed the findings of impaired parenchymal and excretory function of bilateral parotid glands and submandibular salivary glands. He received the diagnosis of SS. Histological examination of the skin specimen revealed the finding of mild basal vacuolization with perivascular and periappendageal lymphohistiocytic infiltrate in the dermis. There was a septal lymphohistiocytic panniculitis [Figure - 2] and [Figure - 3]. Direct immunofluorescence (DIF) staining showed the picture of deposition of granular C3 along the dermoepidermal (DE) junction and positive nuclear IgG stain in the keratinocyte without any dermal vessels deposit. His cutaneous lesions resolved after he received celecoxib and colchicine for 6 weeks. He continuously received hydroxychloroquine for controlling his underlying SS.

Figure 2: Low power view of skin biopsy showed perivascular and periappendage inflammatory cells infiltration and septal panniculitis (H and E, ×40)
Figure 3: Lymphohistiocytic infiltration within subcutaneous adipose tissue (H and E, ×400)

The clinical differential diagnosis of this patient included erythema nodosum (EN), lupus profoundus and other kinds of panniculitis. The pathological examination showed the finding of septal panniculitis with interface change, mild perivascular lymphohistiocytic infiltration in the dermis and positive DIF. All of these findings highly implied connective tissue disease-related panniculitis. The lupus panniculitis should be considered as the first differential diagnosis. But, we did not see the typical pathological change in lupus panniculitis, such as lobular panniculitis and hyalinized fat necrosis with negative reaction in the mucin staining. Clinically, we could exclude infectious diseases (streptococcal infection and Mycobacterium tuberculosis) and other connective tissue disease such as dermatomyositis and rheumatoid arthritis, which might trigger panniculitis.

Panniculitis associated with SS is a rare cutaneous manifestation. Only 9 cases (and 1 with subcutaneous panniculitis-like T cell lymphoma) have been reported in the English literature. [Table - 1] summarizes the clinical and pathological characteristics of these patients. The clinical manifestation usually shows multiple tender erythematous plaques, most commonly over the extremities with symmetrical distribution. The histopathology of panniculitis varies, and mixed lobular and septal panniculitis is most common. The clinical or pathological findings in our patient were both compatible with the SS-related panniculitis.

Table 1: Characteristics of patients with panniculitis associated with Sjögren's syndrome in the English literatures

To our best knowledge, an interface change and positive DIF in our patient have not been reported in the literature. We suggested that like lupus and dermatomyositis panniculitis, SS-related panniculitis could be accompanied with epidermal and dermal change. Based on the observation of our patient and the reports in the literature, we suggested that these pathological changes highly implied connective tissue disease, which is mostly related to the patient′s underlying SS.

We have reported this case to reinforce the relation between SS and panniculitis. The panniculitis could precede the diagnosis of SS. Connective tissue disease, not only the more common lupus erythematosus and dermatomyositis but also SS, should be kept among the differential diagnoses of otherwise unexplainable panniculitis.[6]

Alexander EL, Provost TT. Cutaneous manifestations of primary Sjögren's syndrome: A reflection of vasculitis and association with antiRo (SSA) antibodies. J Invest Dermatol 1983; 80:386-91.
[Google Scholar]
McGovern TW, Erickson AR, Fitzpatrick JE. Sjögren's syndrome plasma cell panniculitis and hidradenitis. J Cutan Pathol 1996; 23: 170-4.
[Google Scholar]
Yamamoto T, Yokoyama A, Yamamoto Y, Mamada A. Erythema nodosum associated with Sjögren's syndrome. Br J Rheumatol 1997:36:707-8.
[Google Scholar]
Tait CP, Yu LL, Rohr J. Sj¨ gren's syndrome and granulomatous panniculitis. Australas J Dermatol 2000; 41:187-9.
[Google Scholar]
Chandrupatla C, Xia L, Stratman EJ. Granulomatous panniculitis associated with Sjögren syndrome. Arch Dermatol 2008; 144: 815-6.
[Google Scholar]
Yokota K, Akiyama Y, Adachi D, Shindo Y, Yoshida Y, Miyoshi Fy et al. Subcutaneous panniculitis-like T-cell lymphoma accompanied by Sjo¨gren's syndrome. Scand J Rheumatol 2009;38:494-5
[Google Scholar]

Fulltext Views

PDF downloads
Show Sections