European Journal of Case Reports in Internal Medicine


The European Journal of Case Reports in Internal Medicine is an official journal of the European Federation of Internal Medicine (EFIM). The journal wants to promote the practice of internal medicine in Europe. Its aim is to provide a forum to internal medicine doctors.
EJCRIM welcomes papers describing unusual or complex cases and case series that an internist may encounter in everyday practice. Case series are also welcomed as long as they demonstrate the appropiateness of a therapeutical approach or unusual manifestation of a disease.
The journal would also consider brief reasoned reports of issues relevant to the practice of Internal Medicine, as well as Abstracts submitted to scientific meetings of European societies of Internal Medicine.

EJCRIM is peer-reviewed with single-blind review and freely accessible to all.

Kapil Kumar Garg, Hapreet Singh
Daniela Dias Alves, Nulita Lourenço, Daniela Franco, Eufémio Calmeiro, Rosa Silva
María García-López, Carlos Cárceles-García, Mariya Ovsepyan, Jara Llenas-Garcia
Yogev Peri, Oshrat Tayer Shifman, Alon Hershko
Hana ZOUBEIDI, Thouraya Ben Salem, Imed Ben Ghorbel, Mohamed Habib Houman
Maria Kyriakopoulou, Guy Decaux, Mike El Mourad, Ruben Casado Arroyo
Hana Zoubeidi, Zohra Aydi, Fatma Daoud, Imen Rachdi, Wafa Koubaa, Raja Jouini, Lilia Baili, Achraf Debbiche, Besma Ben Dhaou, Fatma Boussema
Stefania Scarlini, Marco Gandolfo, Antonello Pietrangelo

Necrotizing Panniculitis as an Uncommon Manifestation of Acute Pancreatitis

Cosimo Marcello Bruno, Gabriele Sebastiano Pricoco, Salvatore Bellinvia, Maria Domenica Amaradio, Damiano Cantone>, Riccardo Polosa
Published: 20/01/2017


Pancreatic panniculitis is a rare disorder affecting 2–3% of patients with pancreatic disease. The findings are characterized by tender, erythematous, subcutaneous nodules which may undergo spontaneous ulceration with discharge of brownish and viscous material derived from colliquative necrosis of adipocytes. The lesions are usually localized in the lower limbs, although they may also extend to the buttocks and also involve the trunk, upper limbs and scalp. They can precede overt pancreatic disease in 40% of cases. The typical histological features observed in these lesions are characterized by necrotic adipocytes with absent nuclei (better known as ‘ghost cells’) in the context of a predominantly lobular panniculitis.
We describe the case of a 78-year-old cirrhotic woman admitted to our department with abdominal pain affecting the upper abdomen and a 3-day fever. On physical examination, multiple tender erythematous nodules, with irregular margins, were present on the pretibial regions of both lower legs, ranging in size from 0.8 to 1.5 cm. Pancreatic amylase and lipase were elevated and abdominal computed tomography revealed acute pancreatitis with oedema, focal gland enlargement of the pancreatic tail and perivisceral inflammation. Histological examination of the lesions was consistent with a diagnosis of necrotizing granulomatous panniculitis.