What are the other Names for this Condition? (Also known as/Synonyms)

• Infection-Induced Panniculitis

What is Infective Panniculitis? (Definition/Background Information)

• Infective Panniculitis is a type of panniculitis, in which inflammation caused by an infectious agent, occurs in the subcutaneous fat tissue just beneath the skin. The term ‘panniculitis’ indicates ‘inflammation of fat tissue’
• Infective Panniculitis is commonly seen with HIV, bacterial, mycobacterial, fungal, viral, and parasitic infections
• The condition causes the presence of painful or painless subcutaneous nodules anywhere in the body; the skin over these nodules may be red in color. There may also be the involvement of many vital organs such as the heart, lungs, kidneys, intestines, and spleen
• Complications may arise from the nodules that include ulceration and bleeding. This can cause scar formation on healing. Complications may also arise from the underlying infectious cause of panniculitis
• The treatment involves the use of antinfectious medications and steroids. The prognosis depends upon many factors including the underlying disease or medical condition causing immunodeficiency, the severity of the signs and symptoms, and the organs that are affected

Who gets Infective Panniculitis? (Age and Sex Distribution)

• Infective Panniculitis is observed most commonly in individuals with immunocompromised states. It may affect individuals of any age group
• Not all cases of Infective Panniculitis are seen in immunocompromised patients
• No racial or ethnic group predilection is observed and the condition is observed worldwide

What are the Risk Factors for Infective Panniculitis? (Predisposing Factors)

The risk factors for Infective Panniculitis include all conditions that can result in a poor immune system, such as:

• HIV infection and AIDS
• Treatment with immunosuppressant medications for recent solid organ transplant
• Administration of chemotherapy for various cancers
• Poorly-controlled diabetes
• Advanced age

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Infective Panniculitis?

Infective Panniculitis is caused by any of the following infectious agents, which include:

• Bacteria such as Streptococcus pyogenes, Staphylococcus aureus, Pseudomonas species, etc.
• Mycobacteria such as Mycobacterium chelonae, M. fortuium, M. abcessus, M. tuberculosis, M. Avium intracellulare, etc.
• Fungus such as Candida species, Aspergillus species, Cryptococcus, Histoplasma, and Sporotrichosis
• Virus such as Cytomegalovirus (CMV)
• Parasitic agents such as nematodes (Gnathostoma spp.) and trematodes (Schistosoma, Fasciola, etc.)

What are the Signs and Symptoms of Infective Panniculitis?

The signs and symptoms of Infective Panniculitis depend upon the type of underlying infection and the body part that is affected.

• The nodules are mostly observed in the thighs and lower legs. The nodules appear in a symmetric pattern and may present with or without any pain
• The subcutaneous nodules may be present on other parts of the body too, such as the chest and back
• Fever
• Tiredness
• Joint and muscle pain
• Weight loss
• Occasional involvement of other organs such as:
  • Pericardium (covering of heart)
  • Pleura (covering of lung), with chest pain and breathing difficulties
  • Fat around the liver and intestines: When this occurs the signs and symptoms may include nausea and vomiting, abdominal pain and enlarged liver (hepatomegaly)

How is Infective Panniculitis Diagnosed?

Infective Panniculitis may be diagnosed using the following tools:

• Complete physical examination with comprehensive evaluation of medical history
• Blood tests:
  • To detect serum amylase and lipase levels
  • CBC with differential may show low white cell count and decreased hemoglobin (anemia)
  • Blood electrolyte may reveal abnormal levels
  • Erythrocyte sedimentation rate (ESR) blood test may show increased ESR
  • C-reactive protein (CRP) blood test may show increased CRP levels
  • May reveal abnormal liver function test
• Blood and tissue culture to detect bacteria, fungus, or virus that is causing the underlying infection responsible for Infective Panniculitis
• Urine tests to check for lipase and amylase levels
• Radiographic studies of the affected region
• Deep skin biopsy: A biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Depending upon the organ involved, the healthcare provider may undertake further studies such as:

• Echocardiogram (for the heart)
• Chest X-ray, CT, or MRI scans of the affected region
• Abdominal ultrasound
• Liver function test

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Infective Panniculitis?

• The complications due to Infective Panniculitis are linked to the underlying condition that caused the weak immune system
• One complication is that the nodules may ulcerate and bleed, resulting in the formation of scars on healing

How is Infective Panniculitis Treated?

The treatment of Infective Panniculitis may involve the following measures:

• Management of the underlying health condition
• Medications, including antibiotics, antifungals, and antiparasitics to treat infections
• Providing reassurance and helping with feelings of stress and anxiety
• Follow-up care with regular screening and checkups are important

How can Infective Panniculitis be Prevented?

Current medical research has not established a method of preventing Infective Panniculitis. However, the cause of infection may be identified and treated to the extent possible.

• Prevention of the underlying infection causing Infective Panniculitis is beneficial
• Also, controlling the risk factors associated with bacterial, fungal, and viral infections can help in preventing the condition

What is the Prognosis of Infective Panniculitis? (Outcomes/Resolutions)

• The prognosis of Infective Panniculitis depends upon the severity of the underlying condition, the signs and symptoms noted, and involvement of the vital organs of the body 
• It also depends upon the overall health status of the individual and the organism causing the infection
• Infective Panniculitis can be a fatal condition, if severe involvement of the heart, lungs, kidneys, or liver occurs

Additional and Relevant Useful Information for Infective Panniculitis:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/skin-disorders/