PMC6864607_01
Panniculitis in the first woman at the admission. It is possible to see the presence of a large area of erythema and lymphangitis.
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C) and severe inflammation on left forearm (Fig. 1). Clinical evaluation revealed the presence of edema, rubor and sever pain (VAS score 8/10) on left forearm, while laboratory test showed a significant increase in both neutrophil cells count (25,500 cell/mmc; normal range 2,500-7,700) and procalcitonin (PCT 5.79 ng/ml; normal range < 0.5 ng/mL), while blood culture failed to detect infections in the bloodstream.
Ultrasound of the forearm: it is possible to note inhomogeneity of the sub-cutis with tissue edema and marked structural disruption of the subcutaneous adipose panniculus.
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Forearm ultrasound documented an area with blurred margins of thickening and with marked structural disruption of the subcutaneous adipose panniculus confirmed by Magnetic Resonance Imaging (MRI), that also showed an edema of both subcutaneous adipose matrix and fibrous septa on the whole forearm on the ulnar side without involvement of the underlying muscle (Figs. 2 and 3).
Magnetic resonance: thickened of sub-cutis and structural disruption of the subcutaneous adipose panniculus.
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F3
Forearm ultrasound documented an area with blurred margins of thickening and with marked structural disruption of the subcutaneous adipose panniculus confirmed by Magnetic Resonance Imaging (MRI), that also showed an edema of both subcutaneous adipose matrix and fibrous septa on the whole forearm on the ulnar side without involvement of the underlying muscle (Figs. 2 and 3).
PMC6864607_02
Panniculitis in the second woman at the admission. It is possible to see the large area of erythema and olecranon bursitis at admission.
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Naranjo probability scale, documented a possible association between Panitumumab and forearm disease (score 6), therefore an empirical antibiotic treatment with Ceftriaxone (1 gr bid) and ciprofloxacin (500 mg bid) plus a corticosteroid (methylprednisolone, 4 mg/day for 4 days) was started with a complete improvement of signs and symptoms in 2 weeks and without the development of adverse drug reactions or drug-drug interactions (Fig. 4).