Subacute nodular migratory panniculitis (SNMP), also known as Vilanova disease, is a rarely encountered variant of erythema nodosum characterized by asymmetric, mildly tender nodules on the lower extremities. The condition, which predominantly affects women in the third to sixth decades of life, typically presents as a single erythematous to brownish nodule on the anterolateral shin. Over time, the lesion often enlarges by peripheral expansion and evolves to form a larger indurated plaque. The plaque does not ulcerate or drain but typically becomes crescentic or arcuate in nature. If left untreated, the lesions of SNMP can persist for months or years and rarely regress spontaneously.
No definitive cause of SNMP has been identified, and the majority of cases appear to be idiopathic. Some case reports have suggested infectious etiologies (particularly streptococcal pharyngitis) and predisposing thyroid disease.
Subacute nodular migratory panniculitis
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Synopsis
Codes
ICD10CM:
M79.3 – Panniculitis, unspecified
SNOMEDCT:
76097009 – Erythema nodosum migrans
M79.3 – Panniculitis, unspecified
SNOMEDCT:
76097009 – Erythema nodosum migrans
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Differential Diagnosis & Pitfalls
Other forms of panniculitis:
- Erythema nodosum – Tender bilateral, symmetric, self-limited nodules, usually preceded by an identifiable infection, autoinflammatory condition, or medication.
- Nodular vasculitis (erythema induratum)
- Pancreatic panniculitis
- Alpha-1 antitrypsin deficiency panniculitis
- Lupus panniculitis – Tender plaques and nodules most commonly affect the upper body of patients with systemic lupus erythematosus.
- Cytophagic histiocytic panniculitis – Nodules tend to ulcerate and drain, and biopsy reveals lobular panniculitis with "beanbag" cells.
- Lipodermatosclerosis – Signs and symptoms of venous insufficiency, including varicose veins, edema, and atrophic skin.
- Subcutaneous panniculitis-like T-cell lymphoma – Skin lesions may be almost identical to SNMP, but immunohistochemical studies will reveal neoplastic T-cells.
- Polyarteritis nodosa – Lower extremity nodules are commonly associated with livedo reticularis. Biopsy reveals medium-vessel vasculitis and inflammation limited to the perivascular zones.
- Necrobiosis lipoidica
- Morphea
- Subcutaneous granuloma annulare
- Rheumatoid nodule – Nontender nodules located on extensor and pressure surfaces of patients with rheumatoid arthritis.
- Sarcoidosis
- Superficial migratory thrombophlebitis – Tender nodules develop along course of a vein with associated thrombosis.
- Arthropod bites
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Last Reviewed:02/12/2018
Last Updated:04/18/2018
Last Updated:04/18/2018
Subacute nodular migratory panniculitis