SHM Converge Scientific Abstract ePoster Gallery-Recurrent Post-Traumatic Inflammatory Panniculitis in Mgus: A Diagnostic Mimic of Cellulitis

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This case describes a 46-year-old woman with uncontrolled type 2 diabetes and IgG kappa MGUS who developed severe right knee erythema, warmth, swelling, fever, and marked inflammatory marker elevation three days after a minor fall. She also had a four-year history of recurrent episodes labeled “cellulitis” after minor trauma.<br /><br />Because she appeared septic, she was initially treated with intravenous antibiotics, but there was no improvement. The clinical picture was disproportionate to the severity of injury, raising concern for a noninfectious inflammatory process. Skin/subcutaneous biopsy showed inflammatory panniculitis with lobular involvement and focal fat necrosis, while cultures and stains were negative for infection. The absence of granulomas or vasculitis helped exclude other inflammatory causes.<br /><br />The authors conclude this was trauma-induced inflammatory panniculitis, likely exaggerated by the patient’s MGUS. MGUS may contribute to dysregulated innate immunity and neutrophil-mediated tissue injury, creating an autoinflammatory response to minor trauma. This case highlights that recurrent “cellulitis” after trauma is not always infection, especially when antibiotics fail.<br /><br />Management changed after biopsy confirmation: the patient improved with colchicine, and mild flares after discharge responded to colchicine and topical steroids. The key teaching point is that biopsy can prevent misdiagnosis and unnecessary antibiotics, and should be considered when erythema is recurrent, trauma-related, and out of proportion to injury.

Asset Subtitle

Caroline C. Wang

Meta Tag

Author List Brittany Doll, Caroline C. Wang, Michelle Sweet

Category Clinical Vignettes

Concept Inflammatory Panniculitis

Concept Lobular Panniculitis

Concept Cellulitis

Concept Infection

Concept Biopsy

Distinguished Non-Finalist

Presenter Organization Rush University Medical College

Presenting Author Caroline C. Wang

Track Adult

Keywords

trauma-induced panniculitis

cellulitis mimic

MGUS

inflammatory panniculitis

lobular panniculitis

type 2 diabetes

biopsy diagnosis

neutrophil-mediated inflammation

colchicine treatment

recurrent erythema

Inflammatory Panniculitis

Lobular Panniculitis

Cellulitis

Infection

Biopsy