European Journal of Case Reports in Internal Medicine - © EFIM
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.
panniculitis ; acute pancreatitis; erythematous nodules; enzymatic fat necrosis; ghost adipocytes.
- Johnson MA, Kannan DG, Balachandar TG, Jeswanth S, Rajendran S, Surendran R. Acute septal panniculitis. A cutaneous marker of a very early stage of pancreatic panniculitis indicating acute pancreatitis. JOP 2005;6:334–338.
- Lengfeld J, Kneitz H, Goebeler M, Kolb-Mäurer A. Panniculitis due to pancreatic disease. J Dtsch Dermatol Ges 2015;13:807–809.
- Colantonio S, Beecker J. Pancreatic panniculitis. CMAJ 2012;184:E159.
- Laureano A, Mestre T, Ricardo L, Rodrigues AM, Cardoso J. Pancreatic panniculitis - a cutaneous manifestation of acute pancreatitis. J Dermatol Case Rep 2014;8:35–37.
- Zellman GL. Pancreatic panniculitis. J Am Acad Dermatol 1996;35(2 Pt 1):282–283.
- Neves Z, Segura U, Valente A, Pacheco MH, Malhado J. Panniculitis - a rare manifestation of acute pancreatitis. GE Port J Gastroenterol 2015;22:117–120.
- Lee WS, Kim MY, Kim SW, Paik CN, Kim HO, Park YM. Fatal pancreatic panniculitis associated with acute pancreatitis: a case report. J Korean Med Sci 2007;22:914–917.