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A 45 year old woman presented with a 4 year history of fever attacks, generalised fatigue, arthralgias, and recurring painful nodules of the subcutaneous tissue in different localisations. Extensive diagnostic procedures had been carried out in several rheumatological and dermatological departments of university hospitals (13 admissions). Under the diagnosis of nodular panniculitis and because of the deep infiltration, incisions and surgical debridement were often necessary. At the physical examination she had a temperature over 39°C, an approximately plum sized painful nodule in the subcutaneous tissue of the left shoulder, and ulcerations of the left hand and elbow (after surgical debridement) (fig 1⇓).
Laboratory tests showed a raised white cell count of 11.6×10 …