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  » Medical Topic Archive  »  Weber-Christian Disease

Weber-Christian Disease


AUTHOR INFORMATION
INTRODUCTION
CLINICAL
DIFFERENTIALS
WORKUP
TREATMENT
MEDICATION
FOLLOW-UP
MISCELLANEOUS
BIBLIOGRAPHY


AUTHOR INFORMATION

Author: Moise L Levy, MD, Program Director, Professor, Departments of Pediatrics and Dermatology, Baylor College of Medicine; Chief of Dermatology Service, Texas Children's Hospital
Coauthor(s): Oren Lifshitz, MD, Resident, Dermatology, Cleveland Clinic Foundation
Moise L Levy, MD, is a member of the following medical societies: American Academy of Dermatology, American Academy of Pediatrics, Society for Investigative Dermatology, and Texas Medical Association
Editor(s): Barry L Myones, MD, Director of Research, Pediatric Rheumatology Center, Texas Children's Hospital at Houston; Associate Professor, Departments of Pediatrics & Immunology, Pediatric Rheumatology Section, Baylor College of Medicine; Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Thomas JA Lehman, MD, Chief, Division of Pediatric Rheumatology, Clinical Professor, Department of Pediatrics, Hospital for Special Surgery and Cornell University; Daniel Rauch, MD, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine; and Norman T Ilowite, MD, Chief, Division of Rheumatology, Schneider Children's Hospital; Professor, Department of Pediatrics, Albert Einstein College of Medicine

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INTRODUCTION

Background: In 1892, Pfeifer first described the skin condition now known as Weber-Christian disease, or idiopathic lobular panniculitis. In 1925, Weber further depicted the syndrome. In 1928, Christian emphasized the significance of fever as part of the syndrome. Henceforth, the syndrome became known as Weber-Christian disease. The nomenclature of this and other related diseases is confusing, and some authors believe that the eponym should be abandoned and that more specific diagnoses should be made on the basis of pathogenesis or cause. Diseases such as lupus panniculitis, factitial panniculitis, panniculitis associated with pancreatic disease, histiocytic cytophagic panniculitis, and alpha1-antitrypsin deficiency panniculitis have been differentiated from Weber-Christian disease. As Weber-Christian disease is elucidated further, additional diseases will probably be identified as being distinct from Weber-Christian disease.

Pathophysiology: Weber-Christian disease is a skin condition that features recurring inflammation in the fat layer of the skin. The involved areas of skin manifest as recurrent crops of erythematous, sometimes tender, edematous subcutaneous nodules. The lesions are symmetric in distribution, and the thighs and lower legs are affected most frequently. Malaise, fever, and arthralgias frequently occur. Nausea, vomiting, abdominal pain, weight loss, and hepatomegaly may also occur. Because its etiology is unknown, Weber-Christian disease is often referred to as idiopathic lobular panniculitis.

Frequency:

  • In the US: Because of the ambiguity of this diagnosis versus other closely related conditions, the frequency of Weber-Christian disease has not been determined.

Mortality/Morbidity: The course of Weber-Christian disease is variable and depends on which organs are affected.

  • Weber-Christian disease may involve the lungs, heart, intestines, spleen, kidney, and adrenal glands. In patients with inflammation involving visceral organs, significant morbidity and mortality may occur.
  • In patients with only cutaneous manifestations, the clinical course may be characterized by exacerbations and remissions of the cutaneous lesions for several years before the disorder subsides.

Race: No racial predilection appears to exist.

Sex: The disease occurs more often in women, who comprise approximately 75% of reported cases.

Age: Weber-Christian disease may occur in young children, but it has been reported most frequently in people in the fourth to seventh decades of life.

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CLINICAL

History: Patients with Weber-Christian disease typically have cutaneous and, less frequently, systemic symptoms.

  • Patients affected with Weber-Christian disease describe crops of lesions that appear and resolve during a period of weeks to months. The lesions are often symmetric in distribution, and the thighs and legs are involved most commonly. Individual nodules regress during the course of a few weeks.
  • Systemic symptoms of Weber-Christian disease include malaise, fever, nausea, vomiting, abdominal pain, weight loss, bone pain, myalgia, and arthralgia.
  • The etiology of Weber-Christian disease is unknown, and patients do not report a history of thermal, mechanical, or chemical trauma.

Physical: Physical examination reveals erythematous, edematous, and tender subcutaneous nodules.

  • The nodules are usually symmetric and measure approximately 1-2 cm; however, the nodules may be much larger. The lesions commonly occur on the thighs and lower legs but may also involve the arms, trunk, and face.
  • The individual nodules resolve during a couple of weeks, leaving an atrophic depressed scar.
  • Occasionally, the epidermis overlying the nodules breaks down, and the lesion discharges a brown liquid oil (ie, liquefying panniculitis).
  • In individuals with Weber-Christian disease with visceral involvement, hepatomegaly or splenomegaly may be present.

Causes: Because its etiology is unknown, Weber-Christian disease is called idiopathic lobular panniculitis. Patients with Weber-Christian disease do not report a history of physical trauma.

  • In some patients with Weber-Christian disease, elevated levels of circulating immune complexes have been noted, suggesting an immunologically mediated reaction.
  • Similarities between Weber-Christian disease and alpha1-antitrypsin deficiency suggest that an altered regulation of a normal inflammatory process may be involved.

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DIFFERENTIALS

Polyarteritis Nodosa
Sarcoidosis
Systemic Lupus Erythematosus
Systemic Sclerosis
Vasculitis and Thrombophlebitis


Other Problems to be Considered:

Alpha1-antitrypsin deficiency panniculitis
Cutaneous polyarteritis nodosa
Eosinophilic fasciitis
Eosinophilic myalgia syndrome
Erythema induratum
Erythema nodosum
Leukemia
Lipodermatosclerosis
Lobular panniculitis
Lymphoma
Pancreatic panniculitis
Poststeroid panniculitis
Sclerema neonatorum
Scleroderma panniculitis
Septal panniculitis
Superficial migratory thrombophlebitis

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WORKUP

Lab Studies:

  • Changes in liver function test results, complete blood cell count, and electrolyte levels reflect visceral involvement of organs, including the lungs, heart, intestines, spleen, kidneys, and adrenal glands.
  • Patients may present with a leukocytosis or leukopenia, anemia, or hypocomplementemia.
  • The erythrocyte sedimentation rate is usually elevated, although the degree of elevation varies.
  • Serum and urine amylase and lipase levels are within the reference range, differentiating Weber-Christian disease from a panniculitis associated with pancreatic disease.
  • The alpha1-antitrypsin level is within the reference range, differentiating Weber-Christian disease from alpha1-antitrypsin panniculitis.

Imaging Studies:

  • Obtain a chest radiograph to exclude autoimmune diseases (eg, sarcoidosis) and infectious diseases (eg, tuberculosis).

Procedures:

  • Skin biopsy is necessary to confirm the diagnosis of panniculitis.
Histologic Findings:

Classification of panniculitis based on histologic criteria

Lobular panniculitis

  • Without vasculitis

    • Idiopathic lobular panniculitis (Weber-Christian disease)

    • Histiocytic cytophagic panniculitis

    • Alpha1-antitrpysin deficiency panniculitis

    • Physical panniculitis

      • Cold induced

      • Traumatic

      • Chemical induced

      • Factitial

    • Neonatal panniculitis

      • Sclerema neonatorum

      • Neonatal subcutaneous fat necrosis

      • Poststeroid panniculitis

    • Lobular panniculitis of systemic disease

      • Pancreatic panniculitis

      • Lupus erythematosus

      • Sarcoidosis

      • Calcifying panniculitis of renal failure

      • Lymphoma and leukemia

      • Infections

  • With vasculitis - Nodular vasculitis (erythema induratum)

Septal panniculitis

  • Without vasculitis

    • Erythema nodosum

    • Scleroderma panniculitis

    • Lipodermatosclerosis

    • Eosinophilic fasciitis

    • Eosinophilic myalgia syndrome

  • With vasculitis

    • Superficial migratory thrombophlebitis

    • Polyarteritis nodosa

    • Cutaneous polyarteritis nodosa

Three histopathologic stages observed in Weber-Christian disease

  • The first stage is characterized by an acute inflammatory reaction, in which lobules of fat are replaced by neutrophils, lymphocytes, and histiocytes.

  • In the second stage, macrophages migrate and phagocytose degenerated fat, forming characteristic "foam cells."

  • In the third stage, the foam cells are replaced by fibroblasts, and the inflammatory reaction is replaced by fibrotic tissue.

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TREATMENT

Medical Care: No uniformly effective therapy for Weber-Christian disease exists.

  • Therapeutic responses have been reported with the use of fibrinolytic agents, hydroxychloroquine, azathioprine, thalidomide, cyclophosphamide, tetracycline, cyclosporine, and mycophenolate.
  • Systemic steroids (eg, prednisone) may be effective in suppressing acute exacerbations.
  • Nonsteroidal anti-inflammatory agents may reduce fever, arthralgias, and other signs of malaise.
  • Involvement of specific organs may require specific supportive drugs.

Surgical Care: No surgical treatment is indicated.

Consultations: Consult a dermatologist to perform a skin biopsy and to consider the wide variety of causes of panniculitis.

Diet: No specific dietary requirements exist.

Activity: Activity is ad lib, and trauma to the affected areas should be avoided.

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MEDICATION

No specific uniformly effective therapy for Weber-Christian disease exists. Therapeutic responses have been reported using fibrinolytic agents, hydroxychloroquine, azathioprine, thalidomide, cyclophosphamide, tetracycline, and mycophenolate. Systemic steroids (eg, prednisone) may be effective in suppressing acute exacerbations. Nonsteroidal anti-inflammatory agents (eg, aspirin, indomethacin) may reduce fever, arthralgias, and other signs of malaise. Involvement of specific organs may require specific supportive drugs.

Drug Category: Corticosteroids -- Used for suppression of acute inflammatory exacerbations. These agents have anti-inflammatory properties and cause profound and varied metabolic effects. They modify the body's immune response to diverse stimuli.

Drug Name
Prednisone (Deltasone, Meticorten, Orasone) -- May decrease inflammation by reversing increased capillary permeability and suppressing PMN activity.
Adult Dose 40-60 mg/d PO qd or divided bid/qid; taper over 2 wk as symptoms resolve
Pediatric Dose 4-5 mg/m2/d PO; alternatively, 0.5-2 mg/kg PO divided bid/qid; taper over 2 wk as symptoms resolve
Contraindications Documented hypersensitivity; viral infection; peptic ulcer disease; hepatic dysfunction; connective tissue infections; fungal or tubercular skin infections; GI disease
Interactions Coadministration with estrogens may decrease prednisone clearance; concurrent use with digoxin
may cause digitalis toxicity secondary to hypokalemia; phenobarbital, phenytoin, and rifampin may increase metabolism of glucocorticoids (consider increasing maintenance dose); monitor for hypokalemia with coadministration of diuretics
Pregnancy B - Usually safe but benefits must outweigh the risks.
Precautions Abrupt discontinuation of glucocorticoids may cause adrenal crisis; hyperglycemia, edema, osteonecrosis, myopathy, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, myasthenia gravis, growth suppression, and infections may occur with glucocorticoid use

Drug Category: Immunomodulators -- Inhibit key factors that mediate immune reactions, which in turn decrease inflammatory responses. May have potential long-term therapeutic response.

Drug Name
Azathioprine (Imuran) -- Antagonizes purine metabolism and inhibits synthesis of DNA, RNA, and proteins. May decrease proliferation of immune cells, which results in lower autoimmune activity.
Adult Dose 1 mg/kg/d PO for 6-8 wk; increase by 0.5 mg/kg q4wk until response occurs or dose reaches 2.5 mg/kg/d
Pediatric Dose Initial dose: 2-5 mg/kg/d PO/IV
Maintenance dose: 1-2 mg/kg/d PO/IV
Contraindications Documented hypersensitivity; low levels of serum TPMT
Interactions Toxicity increases with allopurinol; concurrent use with ACE inhibitors may induce severe leukopenia; may increase levels of methotrexate metabolites and decrease effects of anticoagulants, neuromuscular blockers, and cyclosporine
Pregnancy D - Unsafe in pregnancy
Precautions Increases risk of neoplasia; caution with liver disease and renal impairment; hematologic toxicities may occur; check TPMT level prior to therapy and monitor liver, renal, and hematologic function; pancreatitis rarely associated
Drug Name
Cyclosporine (Neoral, Sandimmune) -- Cyclic polypeptide that suppresses some humoral immunity and, to a greater extent, cell-mediated immune reactions (eg, delayed hypersensitivity, allograft rejection, experimental allergic encephalomyelitis, graft versus host disease) for a variety of organs. For children and adults, base dosing on ideal body weight. Demonstrated to be helpful in variety of skin disorders.
Adult Dose 2.5-5 mg/kg/d PO in divided doses
Pediatric Dose Administer as in adults
Contraindications Documented hypersensitivity; uncontrolled hypertension or malignancies; concomitant administration with PUVA or UVB radiation in psoriasis (may increase risk of cancer)
Interactions Carbamazepine, phenytoin, isoniazid, rifampin, and phenobarbital may decrease cyclosporine concentrations; azithromycin, itraconazole, nicardipine, ketoconazole, fluconazole, erythromycin, verapamil, grapefruit juice, diltiazem, aminoglycosides, acyclovir, amphotericin B, and clarithromycin may increase cyclosporine toxicity; acute renal failure, rhabdomyolysis, myositis, and myalgias increase when taken concurrently with lovastatin
Pregnancy C - Safety for use during pregnancy has not been established.
Precautions Evaluate renal and liver functions often by measuring BUN, serum creatinine, serum bilirubin, and liver enzymes; may increase risk of infection and lymphoma; reserve IV use only for those who cannot take PO
Drug Name
Cyclophosphamide (Neosar, Cytoxan) -- Chemically related to nitrogen mustards. As an alkylating agent, mechanism of action of active metabolites may involve cross-linking of DNA, which may interfere with growth of normal and neoplastic cells. Demonstrated to be helpful in a variety of skin disorders.
Adult Dose 2.5-3 mg/kg/d PO divided qid for nonmalignant disease
Pediatric Dose Administer as in adults
Contraindications Documented hypersensitivity; severely depressed bone marrow function
Interactions Allopurinol may increase risk of bleeding or infection and enhance myelosuppressive effects; may potentiate doxorubicin-induced cardiotoxicity; may reduce digoxin serum levels and antimicrobial effects of quinolones; chloramphenicol may increase half-life while decreasing metabolite concentrations; may increase effect of anticoagulants; coadministration with high doses of phenobarbital may increase rate of metabolism and leukopenic activity; thiazide diuretics may prolong cyclophosphamide-induced leukopenia and neuromuscular blockade by inhibiting cholinesterase activity
Pregnancy D - Unsafe in pregnancy
Precautions Regularly examine hematologic profile (particularly neutrophils and platelets) to monitor for hematopoietic suppression; regularly examine urine for RBCs, which may precede hemorrhagic cystitis
Drug Name
Mycophenolate (CellCept) -- Inhibits inosine monophosphate dehydrogenase (IMPDH) and suppresses de novo purine synthesis by lymphocytes, thereby inhibiting their proliferation. Inhibits antibody production.
Adult Dose 1 g PO bid
Pediatric Dose Not established; 15-23 mg/kg PO bid suggested
Contraindications Documented hypersensitivity
Interactions May elevate levels of acyclovir and ganciclovir; antacids and cholestyramine decrease absorption, reducing levels (do not administer together); probenecid may increase levels of mycophenolate; salicylates may increase toxicity of mycophenolate
Pregnancy B - Usually safe but benefits must outweigh the risks.
Precautions Increases risk of infection; increases toxicity in patients with renal impairment; caution in active peptic ulcer disease
Drug Name
Hydroxychloroquine (Plaquenil) -- Inhibits chemotaxis of eosinophils and locomotion of neutrophils and impairs complement-dependent antigen-antibody reactions.
Adult Dose 310 mg (as base) PO qd or bid for several wk depending on response; 155-310 mg/d for prolonged maintenance therapy
Pediatric Dose 3-5 mg/kg/d (as sulfate) PO qd or divided bid; not to exceed 7 mg/kg/d
Contraindications Documented hypersensitivity; psoriasis; retinal and visual field changes attributable to 4-aminoquinolones
Interactions Serum levels increase with cimetidine; magnesium trisilicate may decrease absorption
Pregnancy C - Safety for use during pregnancy has not been established.
Precautions Caution in hepatic disease, G-6-PD deficiency, psoriasis, and porphyria; not recommended for long-term use in children; perform periodic (6 mo) ophthalmologic examinations; test periodically for muscle weakness
Drug Name
Thalidomide (Thalomid) -- Immunomodulatory agent that may suppress excessive production of TNF-alpha and may down-regulate selected cell-surface adhesion molecules involved in leukocyte migration.
Adult Dose 100-300 mg/d PO qd with water, preferably hs and at least 1 h pc
Start at low end of dose regimen for children <50 kg (110 lb)
Pediatric Dose Not established
Contraindications Documented hypersensitivity
Interactions May increase sedation effects of alcohol, barbiturates, chlorpromazine, and reserpine; because of teratogenic effects, women must use 2 additional methods of contraception or abstain from sexual intercourse
Pregnancy X - Contraindicated in pregnancy
Precautions Perform pregnancy test within the 24-h period prior to initiating therapy, then weekly during first month, followed by monthly tests in women with regular menstrual cycles or q2wk with irregular menstrual cycles; bradycardia may occur; use protective measures (eg, sunscreens, protective clothing) against exposure to sunlight or UV light (eg, tanning beds); prescribing physician must enter STEPS program established by manufacturer
Drug Category: Antibiotics -- Tetracycline has anti-inflammatory activity.
Drug Name
Tetracycline (Sumycin, Achromycin) -- Treats gram-positive and gram-negative organisms, as well as mycoplasmal, chlamydial, and rickettsial infections. Inhibits bacterial protein synthesis by binding with 30S and possibly 50S ribosomal subunit(s).
Adult Dose 250-500 mg PO q6h
Pediatric Dose <8 years: Not recommended
>8 years: 25-50 mg/kg/d PO divided qid; not to exceed 3 g/d
Contraindications Documented hypersensitivity; severe hepatic dysfunction
Interactions Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; can decrease effects of PO contraceptives, causing breakthrough bleeding and increased risk of pregnancy; tetracyclines can increase hypoprothrombinemic effects of anticoagulants
Pregnancy D - Unsafe in pregnancy
Precautions Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy; tetracycline use during tooth development (<8 y) can cause permanent discoloration of teeth; Fanconilike syndrome may occur with outdated tetracyclines
Drug Category: Nonsteroidal anti-inflammatory drugs --
May reduce fever, arthralgia, and pain.
Drug Name
Aspirin (Anacin, Ascriptin, Bayer Aspirin, Bayer Buffered Aspirin) -- Lowers elevated body temperature by vasodilating peripheral vessels, thereby enhancing dissipation of excess heat. Acts on heat-regulating center of hypothalamus to reduce fever. Treats mild to moderate pain. Inhibits prostaglandin synthesis, which prevents formation of platelet-aggregating thromboxane A2.
Short-acting anti-inflammatory agent with rapid absorption in proximal GI tract. Optimally effective only when stable serum levels of 150-250 mcg/L are achieved after 3-5 d of treatment. Serum aspirin levels can be checked after 5-10 d of treatment. Maximal anti-inflammatory action is generally achieved within 2-4 wk, with some further benefit occurring up to 3 mo.
Adult Dose 325-650 mg PO q4-6h; not to exceed 4 g/d
Pediatric Dose 75-100 mg/kg/d PO divided qid; administer with food to minimize gastritis
325-650 mg PO q4-6h in children >40 kg; not to exceed 4 g/d
Contraindications Documented hypersensitivity; liver damage; hypoprothrombinemia; vitamin K deficiency; bleeding disorders; asthma; administration in children (<16 y) with influenzalike illness because of association of aspirin with Reye syndrome
Interactions Effects may decrease with antacids and urinary alkalinizers; corticosteroids decrease salicylate serum levels; additive hypoprothrombinemic effects and increased bleeding time may occur with coadministration of anticoagulants; may antagonize uricosuric effects of probenecid and increase toxicity of phenytoin and valproic acid; doses >2 g/d may potentiate glucose-lowering effect of sulfonylurea drugs
Pregnancy D - Unsafe in pregnancy
Precautions May cause transient decrease in renal function and aggravate chronic kidney disease; avoid use in patients with severe anemia, those with history of blood coagulation defects, or those who are taking anticoagulants; during therapy, regularly question parents and children about eating habits, abdominal pain or diarrhea, tinnitus or subtle hearing loss, behavioral changes, bruising, and epistaxis; family education about potential complications is essential
Drug Name
Indomethacin (Indochron E-R, Indocin) -- Rapidly absorbed; metabolism occurs in liver by demethylation, deacetylation, and glucuronide conjugation. Inhibits prostaglandin synthesis.
Adult Dose 25-50 mg PO bid/tid
75 mg SR PO bid; not to exceed 200 mg/d
Pediatric Dose 1-2 mg/kg/d PO divided bid/qid; not to exceed 4 mg/kg/d or 150-200 mg/d
Contraindications Documented hypersensitivity; GI bleeding; renal insufficiency
Interactions Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effects of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; may increase PT when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently
Pregnancy B - Usually safe but benefits must outweigh the risks.
Precautions Category D in third trimester of pregnancy; acute renal insufficiency, hyperkalemia, hyponatremia, interstitial nephritis, and renal papillary necrosis may occur; increases risk of acute renal failure in patients with preexisting renal disease or compromised renal perfusion; reversible leukopenia may occur (discontinue if persistent leukopenia, granulocytopenia, or thrombocytopenia is present); may cause severe headache in the first few days after initiation of therapy, which usually subsides with continued use; adverse effect sometimes avoided by starting at half dose for 3-4 d with subsequent increase

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FOLLOW-UP

Further Inpatient Care:

  • Inpatient hospitalization and supportive care may be necessary in severe cases of Weber-Christian disease in which inflammation involves visceral organs or for wound care, as indicated.

Further Outpatient Care:

  • Monitor individuals with Weber-Christian disease for progression of the disease and for adverse effects of medications. Routine follow-up care is indicated.

In/Out Patient Meds:

  • No specific uniformly effective therapy exists for Weber-Christian disease.
  • Therapeutic responses have been reported using fibrinolytic agents, hydroxychloroquine, azathioprine, thalidomide, cyclophosphamide, tetracycline, and mycophenolate.
  • Systemic steroids (eg, prednisone) may be effective in suppressing acute exacerbations.
  • Nonsteroidal anti-inflammatory agents may reduce fever, arthralgias, and other signs of malaise.
  • Involvement of specific organs may require specific supportive drugs.
  • When the condition subsides, prophylaxis may be unnecessary.

Deterrence/Prevention:

  • No effective methods of prevention have been discovered.

Complications:

  • Weber-Christian disease may involve the lungs, heart, intestines, spleen, kidney, and adrenal glands. In patients with inflammation involving these critical visceral organs, death may occur.
  • In patients with only cutaneous manifestations, the clinical course may be characterized by exacerbations and remissions of the cutaneous lesions for several years before the disorder subsides.

Prognosis:

  • The prognosis for patients with Weber-Christian disease is highly variable.
  • In patients with only cutaneous manifestations, the clinical course may be characterized by exacerbations and remissions of the cutaneous lesions for several years before the disorder resolves.
  • Patients with severe visceral inflammation of the heart, lungs, intestines, spleen, kidney, or adrenal glands may not survive.

Patient Education:

  • Inform patients of the risks and adverse effects of various treatment options.
  • Select different treatment modalities on an individual basis.

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MISCELLANEOUS

Medical/Legal Pitfalls:

  • Medicolegal pitfalls may involve unusual complications or adverse effects of drug therapy.

Special Concerns:

  • Abrupt discontinuation of steroids may precipitate an adrenal crisis.
  • Medication toxicity may result from drug interactions (ie, cyclosporine with azathioprine) or from liver or kidney impairment.

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BIBLIOGRAPHY

  • Christian HA: Relapsing febrile nodular nonsuppurative panniculitis. In: Archives of Internal Medicine 1928; 41: 338.
  • Eravelly J, Waters MF: Thalidomide in Weber-Christian disease. Lancet 1977 Jan 29; 1(8005): 251[Medline].
  • Freedberg IM, Eisen AZ, Wolff K: Panniculitis. In: Fitzpatrick's Dermatology in General Medicine. Vol 1. New York, NY: Mc-Graw Hill; 1999: 1275-1278.
  • Hood AF, Kwan TH, Mihm ML, Jr: Panniculitis. In: Primer of Dermatopathology. Boston, Mass: Little, Brown and Company; 1993: 450.
  • Lazarus GS: Panniculitis and Disorders of the Subcutaneous Fat. [Full Text].
  • Lebwohl M: Panniculitis. In: Difficult Diagnoses in Dermatology. New York, NY: Churchill Livingstone; 1988: 389-391.
  • Lemley DE, Ferrans VJ, Fox LM, et al: Cardiac manifestations of Weber-Christian disease: report and review of the literature. J Rheumatol 1991 May; 18(5): 756-60[Medline].
  • Moschella SL, Hurley, HJ: Panniculitides. In: Dermatology. Vol 2. Philadelphia, Pa: WB Saunders; 1985: 1175-76.
  • Panush RS, Yonker RA, Dlesk A, et al: Weber-Christian disease. Analysis of 15 cases and review of the literature. Medicine (Baltimore) 1985 May; 64(3): 181-91[Medline].
  • Schuval SJ, Frances A, Valderrama E: Panniculitis and fever in children. J Pediatr 1993 Mar; 122(3): 372-8[Medline].
  • Usuki K, Kitamura K, Urabe A: Successful treatment of Weber-Christian disease by cyclosporin A. Am J Med 1988 Aug; 85(2): 276-8[Medline].
  • Weber EP: A case or relapsing nonsuppurative nodular panniculitis. British Journal of Dermatology 1925; 37: 301.
  • White JW Jr, Winkelmann RK: Weber-Christian panniculitis: a review of 30 cases with this diagnosis. J Am Acad Dermatol 1998 Jul; 39(1): 56-62[Medline].
  • Winkelmann RK, Dahl PR, Perniciaro C, Dahl PM: Asteroid bodies and other cytoplasmic inclusions in necrobiotic xanthogranuloma with paraproteinemia. J Am Acad Dermatol 1998 Jun; 38(6 Pt 1): 967-70[Medline].

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