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» LymeNet Flash » Questions and Discussion » Medical Questions » Panniculitis??

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Author Topic: Panniculitis??
Razzle
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Just got diagnosed with probable panniculitis (inflammation of the fat layer just below the skin; biopsy was taken to confirm). Anyone know if this can be caused by Lyme for sure?

I've seen reference to Dr. Steere's 1988 abstract in which he says, "Lymphoplasmacytic panniculitis of Lyme disease resembles lupus profundus, both in the infiltrate and the plasma cell-blood vessel relationship." (see http://www.ncbi.nlm.nih.gov/pubmed/2847622 ) but am wondering if there is more info about this?

I also wonder about the connection between panniculitis and ACA (the European Lyme rash) - could they be the same or similar (ACA apparently has an inflammatory stage and an atrophic stage; the fat under the skin is lost, leading to the classic thin skin appearance)?

Thanks,

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-Razzle
Lyme IgM IGeneX Pos. 18+++, 23-25+, 30++, 31+, 34++, 39 IND, 83-93 IND; IgG IGeneX Neg. 30+, 39 IND; Mayo/CDC Pos. IgM 23+, 39+; IgG Mayo/CDC Neg. band 41+; Bart. (clinical dx; Fry Labs neg. for all coinfections), sx >30 yrs.

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feelfit
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I know nothing about it Razzle...but by what you've described, I could possibly have this same issue. Interesting, as I also have your swallowing problems, though to a lesser degree.

Who in the world thought to test you for this? PM me with more info, please. Can you describe your fat layer inflammation?

thank you!

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karenl
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Try parasite treatment and cream with amoxy on the skin.I think there is no panniculitis.
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feelfit
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what kind of parasite tx., karen? and how does one get transdermal amoxy? do you have this? all of my fat pads are inflammed. very obvious. can't figure it all out.....grrr.
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karenl
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pm sent
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Razzle
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Feelfit,

I just sent you a PM...

--------------------
-Razzle
Lyme IgM IGeneX Pos. 18+++, 23-25+, 30++, 31+, 34++, 39 IND, 83-93 IND; IgG IGeneX Neg. 30+, 39 IND; Mayo/CDC Pos. IgM 23+, 39+; IgG Mayo/CDC Neg. band 41+; Bart. (clinical dx; Fry Labs neg. for all coinfections), sx >30 yrs.

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Razzle
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This is not a parasite issue in my case...

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-Razzle
Lyme IgM IGeneX Pos. 18+++, 23-25+, 30++, 31+, 34++, 39 IND, 83-93 IND; IgG IGeneX Neg. 30+, 39 IND; Mayo/CDC Pos. IgM 23+, 39+; IgG Mayo/CDC Neg. band 41+; Bart. (clinical dx; Fry Labs neg. for all coinfections), sx >30 yrs.

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Razzle
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So I went to the doctor for the biopsy results and he said the biopsy was "inconclusive" so he's calling it Erethema Nodosum and is having me get some labs drawn to see if he can pinpoint the cause. The lyme test on the biopsy is still pending.

I'll post another update when I have more info.

--------------------
-Razzle
Lyme IgM IGeneX Pos. 18+++, 23-25+, 30++, 31+, 34++, 39 IND, 83-93 IND; IgG IGeneX Neg. 30+, 39 IND; Mayo/CDC Pos. IgM 23+, 39+; IgG Mayo/CDC Neg. band 41+; Bart. (clinical dx; Fry Labs neg. for all coinfections), sx >30 yrs.

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karenl
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Razzle, these biopsies are never showing the real thing as the labs they use cannot test for lyme or other complicated infections.
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Razzle
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So the biopsy showed no lyme, and the biopsy report says the inflammation is non-specific. But it says that the inflammation present is most closely resembling Erethema Nodosum, so that's what I'm diagnosed with.

The blood tests done include the following:

ANA - negative
Pancreas enzymes (amylase, lipase) - normal
Thyroid - normal (TSH = 1.6)
Strep ASO titer - negative
Alpha-1 antitrypsin - normal (no deficiency)
Quantiferon Gold TB test - indeterminate

The doctor is having me repeat the Quantiferon Gold TB test, but I suspect my low T-Cell counts may be influencing the results of the test (it is a relatively new test, and has not been studied in people with compromised immune systems).

Yes, I am aware that the lyme stain was a long-shot, but I figured I had nothing to lose (except a few $$) and if it did show Lyme, then I could wave it under the nose of the idiot ID doctor who told me I couldn't possibly have Lyme when I had just gotten a CDC positive Lyme test result (from Mayo Clinic lab...sent there by him) back in 2008...

[cussing] [rant] [Mad] [shake]

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-Razzle
Lyme IgM IGeneX Pos. 18+++, 23-25+, 30++, 31+, 34++, 39 IND, 83-93 IND; IgG IGeneX Neg. 30+, 39 IND; Mayo/CDC Pos. IgM 23+, 39+; IgG Mayo/CDC Neg. band 41+; Bart. (clinical dx; Fry Labs neg. for all coinfections), sx >30 yrs.

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philly78
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Don't know much about this but I did find an article that may worth reading.

When looking online at the definitin, it states that EN is probably a delayed hypersensitivity reaction to a variety of antigens. It is also stated that it could be related to cat scratch disease. Maybe related to Bart?

Anyway, here is the article.

SUMMARY

Lyme borreliosis (LB) is a multisystemic infectious disease involving the skin, joints, nervous system, heart, and eyes.

Today at least three subtypes pathogenic for humans have been identified: Borrelia burgdorferi sensu stricto, Borrelia garini, Borrelia afzelii.

Different genospecies strains of Borrelia have been associated with different clinical manifestations.

LB is classically described as having three clinical stages or, similarly to syphilis, an early phase and a late one.

The early infection corresponds to the first stage, the late infection includes the second and the third stages.

LB skin manifestations could be divided into five classes. Erythema migrans, lymphadenosis benigna cutis, and acrodermatitis chronica atrophicans are proven skin manifestations of LB.

Lichen sclerosus et athrophicus, morphea, scleroderma, scleredema Buschke, atrophodermia of Pierini and Pasini, Parry-Romberg progressive facial hemiatrophy, and Shulman fasciitis are controversial LB manifestations.

Granuloma annulare, atypical persistent pityriasis rosea, and pityriasis lichenoides are skin lesions occasionally related to LB.

Urticaria, erythema nodosum, and papular acrodermatitis (Giannotti Crosti disease) are reactive LB skin manifestations.

Nodular panniculitis (Pfeifer-Weber-Christian), B-cell cutaneous lymphoma, and juvenile chronic myeloid leukemia are exceptional skin manifestations of LB.

.................................................

Breaking up the paragraph for easier reading for many here -

[ 07-31-2015, 01:20 AM: Message edited by: Robin123 ]

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When faced with pain you have two choices....either quit and accept the circumstances, OR make the decision to fight with all the resources you have at your disposal.

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Razzle
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Thanks. Yeah, there is a really long list of things that can cause EN, and just about every tick-borne bacteria is on the list, as well as a bunch of other infectious organisms, amongst many other things - see http://dermatology.cdlib.org/DOJvol8num1/reviews/enodosum/table1.html for the list...

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-Razzle
Lyme IgM IGeneX Pos. 18+++, 23-25+, 30++, 31+, 34++, 39 IND, 83-93 IND; IgG IGeneX Neg. 30+, 39 IND; Mayo/CDC Pos. IgM 23+, 39+; IgG Mayo/CDC Neg. band 41+; Bart. (clinical dx; Fry Labs neg. for all coinfections), sx >30 yrs.

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gottadance
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I need a LL dermatologist ANYWHERE in US....I live in San Francisco area. AM DESPERATE!!! Have seen 6 derms to no avail. Have had problem for 6 yrs with worsening to point of unbearableness. HELP PLEASE!!!!!!!!
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Marz
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Last night I listened to the free webinar link tincup posted on bartonella. I think they mentioned it there in connection with bart.

I could be wrong and its a lot to listen to since its long. The second speaker was especially interesting.

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Keebler
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-
A rife machine seems a good candidate for treating this, it seems to my mind, at least. Rx may not reach it and rife could. Might be worth looking into this approach.

Hope you find some approach that holds good promise.
-

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