Do my painful skin nodules and fever indicate panniculitis?

Question

Hello doctor,

I am a 37-year-old female with a weight of 143 pounds and a height of five feet five inches. I saw some nodules under my skin with pain when touching them. I have a hard mass under my skin, and it spreads to different parts of the body. I started to have this issue four years back. My blood test shows WBC of 3300 WBC per microliter, RBC of 2.8 million cells/mcL, and ESR of 100 mm/hr. All my other parameters are normal. I have a fever every afternoon along with joint pain.

I am physically weak, and I have lost 17 pounds. I also have varicose vein pain. My stomach remains full even when I take little food. When I eat more, I vomit. I have done two bone marrow biopsies, two skin biopsies, a lymph node biopsy, a lip biopsy, an ultrasound scan, many TB tests, nerve tests, and a SPECT CT scan.

There is no malignancy. All my results are negative. My doctor gave me medicines for TB for two weeks. But it did not help me. I am not taking any other medications. I could not find the cause. Some doctors tell me that this is panniculitis.

Kindly advise.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

Thank you for sharing your reports (attachments were removed for the patient's identity) and providing a detailed history.

I have not seen your lesions visually. But your condition strongly favors erythema nodosum. Your fatigue occurs due to a vitamin D and B12 deficiency. You can start taking vitamin B12 1000 mcg daily. You can also take vitamin D 50,000 IU once a week. I do not know whether you have any issues in your abdomen. But erythema nodosum has an association with Crohn's disease.

I hope this helps you.

Thank you.