Alpha-1-antitrypsin associated panniculitis: The MS variant - 24/08/11
Iowa City, Iowa
Abstract |
Over 90 mutant alleles of the alpha-1-antitrypsin (AAT) gene are recognized and classified by mobility on an acid starch gel. The four major categories include: F=fast, M=medium, S=slow, Z=very slow. Among 41 reported cases of AAT panniculitis, most have the ZZ phenotype with AAT levels below normal. We report two cases of AAT panniculitis with MS phenotype and normal AAT levels. In addition, we review the pathophysiology, epidemiology, and extracutaneous manifestations of AAT disease and propose a diagnostic algorithm for ulcerative panniculitis. A 42-year-old man presented with a solitary plaque on the left thigh exacerbated by trauma or excessive activity. The lesion frequently suppurated with a yellowish oily material. Twenty years before, he had fractured his left femur which was repaired with a metal plate. X-rays, histology with special stains for organisms, and cultures were negative. AAT phenotype was MS and AAT value was normal. A 43-year-old woman presented with multiple plaques on the proximal extremities which suppurated with exercise or trauma. AAT phenotype was MS and AAT level was normal. Histologic exam for both patients showed a dense neutrophilic infiltrate with septal and lobular panniculitis and areas of necrobiosis in the lower reticular dermis.
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Supported by a departmental endowment from the Herzog Foundation, and the generous support of the Joseph Marshall Family of Morningside, Iowa. Preparation of this manuscript was also supported in part by National Institutes of Health (National Institute of Arthritis, Musculoskeletal and Skin Diseases [NIAMS]) grant AR19101. Its contents are solely the responsibility of the author and do not necessarily represent the official views of NIAMS. Conflicts of Interest: None identified. |
Vol 51 - N° 4
P. 645-655 - octobre 2004 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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