Necrotizing Panniculitis as an Uncommon Manifestation of Acute Pancreatitis

  • Cosimo Marcello Bruno Unit of Internal and Emergency Medicine, G. Rodolico Hospital, A.O.U. “Policlinico - Vittorio Emanuele”, Catania Department of Clinical and Experimental Medicine, University of Catania, Catania
  • Gabriele Sebastiano Pricoco Unit of Internal and Emergency Medicine, G. Rodolico Hospital, A.O.U. “Policlinico - Vittorio Emanuele”, Catania
  • Salvatore Bellinvia Unit of Internal and Emergency Medicine, G. Rodolico Hospital, A.O.U. “Policlinico - Vittorio Emanuele”, Catania
  • Maria Domenica Amaradio Unit of Internal and Emergency Medicine, G. Rodolico Hospital, A.O.U. “Policlinico - Vittorio Emanuele”, Catania
  • Damiano Cantone Unit of Internal and Emergency Medicine, G. Rodolico Hospital, A.O.U. “Policlinico - Vittorio Emanuele”, Catania
  • Riccardo Polosa Unit of Internal and Emergency Medicine, G. Rodolico Hospital, A.O.U. “Policlinico - Vittorio Emanuele”, Catania Department of Clinical and Experimental Medicine, University of Catania, Catania
Keywords: panniculitis, acute pancreatitis, erythematous nodules, enzymatic fat necrosis, ghost adipocytes.

Abstract

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.

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  • Published: 2017-04-27

    Issue: Vol 4 No 3 (view)

    Section: Articles

    How to cite:
    Bruno, C. M., Pricoco, G., Bellinvia, S., Amaradio, M. D., Cantone, D., & Polosa, R. (2017). Necrotizing Panniculitis as an Uncommon Manifestation of Acute Pancreatitis. European Journal of Case Reports in Internal Medicine, 4(3). https://doi.org/https://doi.org/10.12890/2017_000540