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Panniculitis as a manifestation of metal-associated autoimmune/inflammatory syndrome induced by adjuvants: a case-based review

  • Case Based Review
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Abstract

Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) is associated with a hyperergic response of the immune system. The spectrum of clinical changes in ASIA is extensive and difficult to diagnose. Panniculitis is a heterogeneous group of diseases characterized by lesions of the adipose tissue. Panniculitis may become one of the signs of ASIA progress.

To describe the clinical signs and morphological changes in the subcutaneous fat as a manifestation of ASIA, developing after osteosynthesis with metal structures.

In this case-based review, were searched for all articles published in PubMed and Scopus databases until March, 2021 using the following keywords “panniculitis”, “erythema nodosum”, “Weber-Christian Disease”, “idiopathic lobular panniculitis”, “Autoimmune/inflammatory syndrome induced by adjuvants”, “Shoenfeld’s syndrome”, “metal allergy” “metal implants”, “metal hypersensitivity” and reviewed them. Irrelevant items and duplicates were excluded.

We report a case of an adult female patient presenting with a non-healing uninfected surgical wound following implantation of metal osteosynthesis construction and panniculitis developed after surgery. A comprehensive examination of the patient to check for ASIA was conducted. Considering the medical history of exposure to metals, tissue lesions, arthralgia, myalgia, low-grade fever, the disappearance of symptoms on the background of immunosuppressive therapy suggested the diagnosis of ASIA.

Report affords clinicians and pathologists additional insight into the clinical and morphological picture of ASIA-associated panniculitis which, if remain unidentified, may cause severe complications. We recommend the removal of constructions with adjuvant activity in patients with suspected ASIA-associated manifestations.

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Authors and Affiliations

  1. I.M. Sechenov First Moscow State Medical University, Ministry of Health, RF (Sechenov University), Moscow, Russia

    S. G. Radenska-Lopovok & A. O. Kolesnikova

  2. V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia

    O. N. Egorova, M. V. Severinova & I. D. Musatov

Authors
  1. S. G. Radenska-Lopovok
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  2. A. O. Kolesnikova
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  3. O. N. Egorova
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  4. M. V. Severinova
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  5. I. D. Musatov
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Contributions

Substantial contributions to the management of the case and design of this case-based review were made by all the authors. SG: project manager, review and analyzing the literature, editing the manuscript. AO: review and analyzing the literature, writing the manuscript. ON: patient’s supervising. MV: ultrasound examination providing. ID: patient’s treating. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to S. G. Radenska-Lopovok.

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The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the V.A. Nasonova Research Institute of Rheumatology Ethics Committee, reference number 2 on the 31/01/2013 and number 28 on the 13/11/2014.

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Informed consent was obtained from the patient included in the study.

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Radenska-Lopovok, S.G., Kolesnikova, A.O., Egorova, O.N. et al. Panniculitis as a manifestation of metal-associated autoimmune/inflammatory syndrome induced by adjuvants: a case-based review. Rheumatol Int 43, 1547–1553 (2023). https://doi.org/10.1007/s00296-021-04924-1

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