Fatal pancreatic panniculitis associated with acute pancreatitis: a case report

Abstract

Pancreatic panniculitis is a rare disease in which necrosis of fat in the panniculus and other distant foci occurs in the setting of pancreatic diseases; these diseases include acute and chronic pancreatitis, pancreatic carcinoma, pseudocyst, and other pancreatic diseases. This malady is manifested as tender erythematous nodules on the legs, buttock, or trunk. Histopathologically, it shows the pathognomonic findings of focal subcutaneous fat necrosis and ghost-like anucleated cells with a thick shadowy wall. We herein report a case of fatal pancreatic panniculitis that was associated with acute pancreatitis in a 50-yr-old man. He presented with a 3-week history of multiple tender skin nodules, abdominal pain and distension. Laboratory and radiologic findings revealed acute pancreatitis, and skin biopsy showed pancreatic panniculitis. Despite intensive medical care, he died of multi-organ failure 3 weeks after presentation.

Fig. 1

Multiple erythematous to brownish nodules are shown on both lower legs.

Fig. 2

(A) Contrast-enhanced computed tomography showing an edematous pancreas with dilated pancreatic duct. (B) Loculated fluid at left anterior perirenal space with massive ascites was noted (arrow).

Fig. 3

(A) Diffuse fat necrosis and fine granular basophilic material deposited in the subcutis. (B) Ghost-like fat cells with thick shadowy walls and no nuclei are noted in the necrotic area (Hematoxylin-eosin stain, A: ×40, B: ×200).