Recurrent Febrile Panniculitis with Respiratory Failure: A Case Report

Febrile panniculitis encompasses a heterogeneous group of inflammatory, infectious, and neoplastic disorders, and the historical label Weber-Christian disease should be used only with caution after more specific causes have been excluded. We report a 61-year-old woman with two months of recurrent remittent fever, cough, progressive dyspnea, weight loss, and episodic erythematous lesions that appeared one to two days before each febrile episode and faded with residual hyperpigmentation. Broad infectious and autoimmune investigations were unrevealing, and antibacterial therapy produced no improvement. Hypoxemic respiratory failure worsened during hospitalization, requiring high-flow nasal oxygen. A deep skin biopsy showed mixed septal and lobular inflammation with focal liquefactive fat necrosis and neutrophilic infiltration, supporting acute panniculitis. Her family subsequently reported marked improvement after systemic glucocorticoid therapy, although intermittent recurrence persisted during six months of follow-up. The close temporal coupling of fever and cutaneous inflammation, together with severe respiratory compromise, makes this presentation clinically instructive. However, pulmonary panniculitis could not be established without respiratory-tissue histology. This case supports a pattern-based diagnosis of idiopathic febrile panniculitis rather than uncritical use of an eponym-Weber-Christian disease, and highlights the need for deep biopsy, systematic exclusion of secondary causes, and longitudinal diagnostic reassessment.