Panniculitis masquerading as generalised lymphadenopathy in a neonate: a diagnostic dilemma - a case report and a mini review.
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BACKGROUND: Generalised lymphadenopathy is rare in neonates and often suggests a serious systemic illness, including malignancy, immune dysregulation or congenital infection. Panniculitis is not commonly considered as a differential diagnosis in this age group. This case report highlights the diagnostic dilemma posed by panniculitis masquerading as generalised lymphadenopathy in a neonate. CASE PRESENTATION: A late preterm male infant was referred from an outlying hospital on the sixth day of life with respiratory distress and cyanosis. By the eleventh day of life, multiple discrete, firm nodular swellings had developed over the anterior neck, supraclavicular, axillary, epigastric, inguinal, and truncal regions, initially presumed to represent generalized lymphadenopathy. The infant had a history of severe perinatal asphyxia and presented with hypoxaemia. Blood culture confirmed Enterobacter cloacae septicaemia. Concurrently, baseline semi-quantitative polymerase chain reaction (PCR) testing demonstrated an intense amplification band for cytomegalovirus (CMV) in both the mother and the infant. Histopathological examination of the skin biopsy showed reactive (non-specific) panniculitis with concurrent systemic CMV and bacterial sepsis. There was no hepatosplenomegaly. Laboratory evaluation showed thrombocytopenia and leukocytosis, with normal liver function tests, electrolytes, urea, creatinine, and serum calcium levels. Management entailed broad-spectrum intravenous antibiotics, continuous positive airway pressure (CPAP), and valganciclovir. Following complete resolution of the nodules and progressive clinical stabilization, the infant was discharged after a 19-day admission. Serial semi-quantitative PCR monitoring confirmed complete viral clearance at four months with multidisciplinary follow-up arranged. CONCLUSION: Panniculitis masquerading as generalized lymphadenopathy is an unusual finding in neonates. Early biopsy with histopathological evaluation is essential to avoid misdiagnosis, particularly in the presence of overlapping clinical factors such as CMV infections, sepsis or perinatal stress.