Pancreatic panniculitis - a cutaneous manifestation of acute pancreatitis

Abstract

Background: Pancreatic panniculitis is a rare complication of pancreatic disease occurring in 2% to 3% of all patients, most commonly those with acute or chronic pancreatitis.

Main observations: We report the case of a pancreatic panniculitis associated with acute pancreatitis in a 63-year-old man. He presented with a 2-day history of multiple tender subcutaneous nodules, followed by nausea, vomiting, severe epigastric pain and loss of appetite, hours before admission. Laboratory and radiologic findings revealed acute pancreatitis. Histopathological examination from a skin biopsy specimen taken from a nodule showed a mostly lobular panniculitis with "ghost cells", without vasculitis. Nodules disappeared with the resolution of acute pancreatic inflammation, as amylase and lipase levels returned to normal.

Conclusions: Panniculitis may be the first manifestation of pancreatic disease. Therefore clinicians must have a high index of suspicion for the diagnosis of pancreatic panniculitis.

Keywords: acute pancreatitis; adypocites; arthritis; chronic pancreatitis; differential diagnosis; erysipelas; erythema nodosum; fever.

Figure 1

Multiple, ill-defined, erythematous subcutaneous nodules on the legs (A), thights (B) and arms (C); spontaneous brown oily drainage was seen in some nodules (D).

Figure 2

Histopathological examination of a nodule: (A) mostly lobular panniculitis without vasculitis, with focal necrosis of adipocytes surrounded by neutrophils (Hematoxylin-eosin, original magnification x10); (B) "ghost cells" consisting of anucleate necrotic adipocytes with a basophilic granular material within their cytoplasm (Hematoxylin-eosin, original magnification x100).