Weber-Christian disease: ultrasound can see it

Weber-Christian disease, also known as idiopathic relapsing febrile nodular non-suppurative panniculitis, is a rare inflammatory disorder of the subcutaneous tissue characterized by recurrent nodules often associated with constitutional symptoms, in particular pain and fever. A 50-year-old female patient underwent ultrasound examination of the soft tissues because of relapsing painful subcutaneous nodules of the left arm, accompanied by fever. Ultrasonography showed subcutaneous nodules suggestive of panniculitis. An ultrasound-guided biopsy was performed. The ultrasound-guided biopsy from the nodules with mixed echostructure revealed lobular panniculitis with a mixed cell infiltrate, consistent with Weber-Christian disease, after clinical and pathological exclusion of several differential diagnoses. Recurrent painful subcutaneous nodules associated with fever necessitate a careful medical history and thorough physical examination. Ultrasound can be useful to formulate the hypothesis of panniculitis. Histological examination of a ultrasound-guided biopsy of a nodule with mixed echostructure is needed to confirm the diagnosis. Weber-Christian disease remains a diagnosis of exclusion, when no other cause for the lobular panniculitis can be identified.