Panniculitis Masquerading as Generalised Lymphadenopathy in a Neonate: A Diagnostic Dilemma – A Case Report

Background: Generalised lymphadenopathy is rare in neonates and often suggests a serious systemic illness, including malignancy 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 presenting as generalised lymphadenopathy in a neonate. Case Presentation: A late preterm male infant presented with respiratory distress and cyanosis, and by the 11th day of life, developed multiple firm, tender nodular swellings over the neck, axillae, epigastrium, groin, and trunk, initially presumed to be generalized lymphadenopathy. He had a history of birth asphyxia and a family history of childhood deaths. He was managed for neonatal sepsis. DNA PCR confirmed congenital cytomegalovirus (CMV) infection, and histology revealed panniculitis. Treatment included broad-spectrum antibiotics, respiratory support via CPAP, and oral ganciclovir. He showed clinical improvement and was discharged in stable condition with multidisciplinary follow-up arranged. Conclusion Panniculitis presenting as generalised lymphadenopathy is unusual finding in neonates. Early biopsy and histopathological confirmation are essential in avoiding misdiagnosis.