Bilateral heel panniculitis presenting as calcaneal osteomyelitis

Panniculitis is an inflammatory process of the subcutaneous adipose layer (panniculos adiposus). It is frequently a sign of systemic disease with a wide range of clinical presentations. The histopathological findings are diverse, making diagnoses difficult. We present a case of heel panniculitis, initially misdiagnosed as calcaneal osteomyelitis. Our intention is to make physicians, treating these type of patients, aware of the possibility of this rare disease, especially in situations when conventional therapy is not successful. A 66-year-old woman was admitted to the hospital with the initial diagnosis of suspected calcaneal osteomyelitis of her right heel, presumably due to a foreign body penetration a few months prior. Initial treatment with intravenous antibiotics was unsuccessful. When significant fluctuation developed, she underwent incision and drainage of her right heel. Postoperatively, her right heel condition did not improve and similar phenomena appeared on her left side. She continued to deteriorate up to the point when panniculitis was diagnosed and corticosteroid treatment was initiated. Her condition rapidly improved after this treatment.