Rare pancreatic diseases
Pancreatic panniculitis: A rare form of panniculitis
1. Senior Registrar, Department of Dermatology
NP Madarasingha MD1, K Satgurunathan MD2, Ruchira Fernando MD3
Dermatology Online Journal 15 (3): 17
2. Consultant Dermatologist, Department of Dermatology
3. Consultant Pathologist, Department of Pathology
National Hospital of Sri Lanka, Columbo, Sri Lanka. email@example.com
Pancreatic panniculitis is rare form of panniculitis with associated pancreatic disease. The skin manifestations can occur at any time of the pancreatic pathology. Here we report a case of pancreatic panniculitis associated with underlying chronic pancreatitis. The patient presented with painful subcutaneous nodules and the histology revealed the characteristic features of pancreatic panniculitis.
Pancreatic panniculitis is a rare cutaneous manifestation in patients with underlying pancreatic disease. It is mostly associated with acute or chronic pancreatitis and pancreatic carcinoma, frequently of acinar cell type . Less frequent associations include pseudocyst, vasculopancreatic fistulas and pancreas divisum. The skin manifestation can predate, occur concurrently with, or lag behind the pancreatic pathology [, ].
A 35-year-old male presented with a 4 week history of painful subcutaneous nodules on shins and buttocks. He had loss of weight and loss of appetite. He did not have fever, arthralgia, or chronic cough and his bowel habits were normal. He reported consumption of about half a bottle of hard liquor per day. Three months prior to presentation he had an episode of severe central abdominal pain associated with nausea and vomiting and was diagnosed as having chronic pancreatitis.
Physical examination revealed multiple tender subcutaneous nodules over the ankle region, shins, thighs, and buttocks. The overlying skin was erythematous with no change in skin texture. None of the lesions was ulcerated. Systemic examination was normal except for mild pallor. Clinically, the possibilities of erythema nodosum, erythema induratum, or pancreatic panniculitis were entertained. Whitish oily material was noted when performing the incisional biopsy, favoring fat necrosis.
His erythrocyte sedimentation rate (ESR) was 26 mm; hemoglobin was 9.2 g/dl with normal white cells and platelets and additional testing suggested anemia of chronic disease. Antistreptolysin O titer (ASOT) was
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